Common use of Level Appeal Clause in Contracts

Level Appeal. If You are dissatisfied that We denied Benefits, You can ask Us to review Your case. You or Your authorized representative must first write to Us within 180 days after We denied Benefits. If We receive Your request after 180 days, We will not consider it. Write to: Blue Cross and Blue Shield of Louisiana Appeals and Grievance Unit P. O. Box 98045 Baton Rouge, LA 70898-9045 If You have questions or need help writing the Appeal, call: Customer Service Department 0-000-000-0000 or 0-000-000-0000 When We receive Your request for a first-level Appeal, We will investigate Your concerns. Within 30 working days after We receive Your request for a first-level Appeal, We will write to You, unless You, Your authorized representative, and We agree that We have more time to respond. ◼ If We change Our original decision at this level, We will process Your Claim and will write to You and all appropriate providers. ◼ If We do not change Our original decision, We will write to You and all appropriate providers to explain that You can ask for a second-level Appeal.

Level Appeal. If You are dissatisfied that We denied Benefits, You can ask Us to review Your case. You or Your authorized representative must first write to Us within 180 days after We denied Benefits. If We receive Your request after 180 days, We will not consider it. Write to: Blue Cross and Blue Shield of Louisiana Appeals and Grievance Unit P. O. Box 98045 Baton Rouge, LA 70898-9045 If You have questions or need help writing the Appeal, call: Customer Service Department 0-000-000-0000 or 0-000-000-0000 When We receive Your request for a first-level Appeal, We will investigate Your concerns. Within 30 working days after We receive Your request for a first-level Appeal, We will write to You, unless You, Your authorized representative, and We agree that We have more time to respond. ◼  If We change Our original decision at this level, We will process Your Claim and will write to You and all appropriate providers. ◼  If We do not change Our original decision, We will write to You and all appropriate providers to explain that You can ask for a second-level Appeal.

Level Appeal. If You are dissatisfied that We denied Benefits, You can ask Us to review Your case. You or Your authorized representative must first write to Us within 180 days after We denied Benefits. If We receive Your request after 180 days, We will not consider it. Write to: Blue Cross and Blue Shield of Louisiana Appeals and Grievance Unit Appeals/Grievances Department P. O. Box 98045 Baton Rouge, LA 70898-9045 If You have questions or need help writing the Appeal, call: Customer Service Department 0-000-000-0000 or 0-000-000-0000 When We receive Your request for a first-level Appeal, We will investigate Your concerns. Within 30 working days after We receive Your request for a first-level Appeal, We will write to You, unless You, Your authorized representative, and We agree that We have more time to respond. ◼ If We change Our original decision at this level, We will process Your Claim and will write to You and all appropriate providers. ◼ If We do not change Our original decision, We will write to You and all appropriate providers to explain that You can ask for a second-level Appeal.