Common use of Medical Appeals Clause in Contracts

Medical Appeals. Medical Appeals involve Adverse Benefit Determinations for Medical Necessity, appropriateness, healthcare setting, level of care, or effectiveness or is determined to be experimental or Investigational and any related prospective or retrospective review determination. We offer the Member two (2) standard levels of medical Appeals, including an internal review of the initial Adverse Benefit Determination, then an external review. Medical Appeals should be submitted in writing to: Blue Cross and Blue Shield of Louisiana Medical Appeals P. O. Box 98022 Baton Rouge, LA 70898-9022

Medical Appeals. Medical Appeals involve Adverse Benefit Determinations for Medical Necessity, appropriateness, healthcare health care setting, level of care, or effectiveness or is determined to be experimental or Investigational and any related prospective or retrospective review determination. We offer the Member two (2) standard levels of medical Appeals, including an internal review of the initial Adverse Benefit Determination, then an external review. Medical Appeals should be submitted in writing sent to: Blue Cross and Blue Shield of Louisiana Medical Appeals P. O. Box 98022 Baton Rouge, LA 70898-9022