Common use of Appeal of a Pre-Service Claim Clause in Contracts

Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives the Claimant’s request; except in limited cases when AvMed provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 33 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract

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Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days one (1) year of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives the Claimant’s request; except in limited cases when AvMed provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 6 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract

Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days 1 year of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives the Claimant’s request; except in limited cases when AvMed provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 3 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract With Point of Service Rider, Medical and Hospital Service Contract

Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives the Claimant’s request; except in limited cases when AvMed XxXxx provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 2 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract

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Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives AvMex xxxeives the Claimant’s request; except in limited cases when AvMed provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 1 contract

Samples: Medical and Hospital Service Contract

Appeal of a Pre-Service Claim. A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination. AvMed will review the Claim and notify the Claimant of its determination on review, no later than 30 days after XxXxx receives AvXxx xeceives the Claimant’s request; except in limited cases when AvMed provides new information to the Claimant that AvMed is considering in the appeal, and gives the Claimant an opportunity to respond. An appeal of an Adverse Benefit Determination with respect to a Pre-Service Claim may be submitted to: AvMed Member Engagement Center P.O. Box 569008 Miami, Florida 00000-0000 Telephone: 0-000-000-0000 Fax: (000) 000-0000

Appears in 1 contract

Samples: Medical and Hospital Service Contract

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