CLAIMS APPEALS. In the event of any disagreement between the Insured and the Insurer regarding this Insurance Policy and/or its provisions, the Insured, before commencing any arbitration or legal proceedings, shall request a review of the matter by the “Bupa Insurance Company Appeals Committee”. In order to begin such a review, the Insured must submit a written request to the Appeals Committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of what decision should be reviewed and why. Said appeals shall be sent to the attention of the Bupa Insurance ADMINISTRATION Company Appeals Coordinator, c/o USA Medical Services. Upon the submission of a request for review, the Appeals Committee will determine whether any further information and/or documentation is needed and act to timely obtain such. Within thirty (30) days thereafter, the Appeals Committee will notify the Insured of its decision and the underlying rationale.
CLAIMS APPEALS. In the event of a disagreement between the insured and the insurer regarding this insurance policy and/or its conditions, before beginning any arbitration or legal proceeding, the insured shall request a review of the matter by the insurer’s appeals committee. In order to begin such review, the insured must submit a written request to the appeals committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of the decision that should be reviewed and why. The request shall be sent to the attention of the insurer’s appeals coordinator, c/o USA Medical Services. Upon submission of a request for review, the appeals committee will determine whether any further information and/ or documentation is needed and act to timely obtain it. The appeals committee will notify the insured of its decision and the underlying rationale within thirty (30) days.
CLAIMS APPEALS. In the event of any disagreement between the Insured and the Insurer regarding this Insurance Policy and/or its provisions, the Insured, before commencing any arbitration or legal proceedings, shall request a review of the matter by the “ASSURIA MEDISCHE VERZEKERING N.V. Appeals Committee”. In order to begin such a review, the Insured must submit a written request to the Appeals Committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of what decision should be reviewed and why. Said appeals shall be sent to the attention of the ASSURIA MEDISCHE VERZEKERING N.V. Appeals Coordinator, c/o Redbridge Network & Healthcare, Inc. Upon the submission of a request for review, the Appeals Committee will determine whether any further information and/or documentation is needed and act to timely obtain such. Within thirty (30) days thereafter, the Appeals Committee will notify the Insured of its decision and the underlying rationale.
CLAIMS APPEALS. Administrative Agent shall refer to Employer or its Plan Administrator or other designee, for final determination, any Claim for benefits or coverage that is appealed after initial rejection by Administrative Agent or any class of Claims that Employer may specify, including:
CLAIMS APPEALS. SISC FLEX shall make final determination regarding any claim for benefits on coverage that is appealed after initial rejection including: (a) any question of eligibility or entitlement of the claimant for coverage under the Plan; (b) any question with respect to the amount due; or (c) any other appeal.
CLAIMS APPEALS. Contractor shall be responsible for processing claims and claims appeals in accordance with applicable Laws. DFR is the primary regulatory authority responsible for enforcing the State and federal laws relating to claims appeals. Contractor acknowledges and agrees that the State and DFR may communicate regarding claims appeals and processes thereto and that, consistent with State and federal privacy and security laws, the State and DFR may exchange information to support this Contract and DFR’s enforcement activities.
CLAIMS APPEALS. If your claim has been denied, or any other adverse benefit determination is made regarding your claim, and you wish to submit your claim for review, you must file your claim for review, in writing, with the Plan Administrator. You must file the claim for review no later than 60 days after you have received written notification of the denial of your claim for benefits (or, if none was provided, no later than 60 days after the deemed denial of your claim). In connection with the request for review, you (or your duly authorized representative) may submit to the Plan Administrator written comments, documents, records, and other information relating to the claim. In addition, you will be provided, upon written request and free of charge, with reasonable access to (and copies of) all documents, records, and other information relevant to the claim. The review by the Plan Administrator will take into account all comments, documents, records, and other information you submit relating to the claim. The Plan Administrator will make a final written decision on a claim review, in most cases, within 60 days after receiving your written claim for review. In some cases, your claim may take more time to review, and an additional processing period of up to 60 days may be required. If that happens, you will be notified in writing. The written notice of extension will indicate the special circumstances requiring the extension of time and the date by which the Plan Administrator expects to make a determination with respect to the claim. If the extension is required due to your failure to submit information necessary to decide the claim, the period for making the determination will be tolled from the date on which the extension notice is sent to you until the date on which you respond to the Plan Administrator’s request for information. The Plan Administrator’s decision on your claim for review will be communicated to you in writing. If an adverse benefit determination is made, this notice will include (i) the specific reasons(s) for the adverse benefit determination with references to the specific Plan provisions on which the determination is based; (ii) a statement that you are entitled to receive, upon request and free of charge, reasonable access to (and copies of) all documents, records and other information relevant to the claim; and (iii) a statement of your right to bring a civil action under Section 502(a) of ERISA. All interpretations, determinations and decisions of...
CLAIMS APPEALS. In the event of any disagreement between the Insured and the Insurer regarding this Insurance Policy and/or its pro- visions, the Insured, before com- mencing any arbitration or legal proceedings, shall request a review of the matter by the “Bupa Insur- ance Company Appeals Commit- tee”. In order to begin such a review, the Insured must submit a written request to the Appeals Committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of what decision should be reviewed and why. Said appeals shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Services. Upon the sub- mission of a request for review, the ADMINISTRATION Appeals Committee will determine whether any further information and/ or documentation is needed and act to timely obtain such. Within thirty
CLAIMS APPEALS. ASIFlex agrees to refer to Client or its designee, Plan Administrator, and/or Named Fiduciary for the following: • The second and final level of appeal of an adverse benefit determination; and • Any class of claims Client may specify, including: ο Questions of eligibility or entitlement of the claimant for coverage under the Program; ο Questions with respect to the amount due; or ο Any other appeal.
CLAIMS APPEALS. Administrator shall refer to Client or Client’s designee, for final determination, any claim for benefits or coverage that is appealed after initial rejection by the Administrator. Administrator shall similarly refer to Client or Client’s designee any class of claims the Client may specify, including: (a) any question of eligibility or entitlement of the claimant for coverage under the Plan; (b) any question with respect to the amount due; or (c) any other appeal.
