Common use of Medical Services Clause in Contracts

Medical Services. The Member, a designated representative, or a provider on behalf of the Member, may contact the Customer Service Department by telephone, letter, or online to request a review of an initial determination concerning a claim or service. Members may contact the plan at the telephone number as noted on the back page of this Evidence of Coverage and Health Service Agreement. If the telephone inquiry to Customer Service does not resolve the question or issue to the Member’s satisfaction, the Member may request a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate a grievance by submitting a letter or a completed “Grievance Form”. The Member may request this Form from Customer Service. The completed form should be submitted to Customer Service Appeals and Grievance, P.O. Box 5588, El Dorado Hills, CA 95762-0011. The Member may also submit the grievance online by visiting xxx.xxxxxxxxxxxx.xxx. Blue Shield will acknowledge receipt of a grievance within five calendar days. Grievances are resolved within 30 days. The grievance system allows Subscribers to file grievances for at least 180 days following any incident or action that is the subject of the Member’s dissatisfaction. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the request. An expedited decision may involve admissions, continued stay, or other healthcare services. For additional information regarding the expedited decision process, or to request an expedited decision be made for a particular issue, please contact Customer Service.

Medical Services. The Member, a designated representative, or a provider on behalf of the Member, may contact the Customer Service Department by telephone, letter, or online to request a review of an initial determination determina- tion concerning a claim or service. Members may contact the plan Blue Shield at the telephone number as noted on the back page of this Evidence of Coverage and Health Service AgreementEOC. If the telephone tele- phone inquiry to Customer Service does not resolve the question or issue to the Member’s satisfaction, the Member may request a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate a grievance by submitting a letter or a completed “Grievance Form”. The Member may request this Form from Customer Service. The completed form should be submitted to Customer Service Appeals and Grievance, P.O. Box 5588, El Dorado Hills, CA 95762-0011. The Member may also submit the grievance online by visiting our web site at xxx.xxxxxxxxxxxx.xxx. Blue Shield will acknowledge receipt of a grievance within five calendar days. Grievances are resolved within 30 days. The grievance system allows Subscribers Sub- scribers to file grievances for at least 180 days following fol- lowing any incident or action that is the subject of the Member’s dissatisfaction. See the previous Cus- tomer Service section for information on the expe- dited decision process. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following fol- lowing the receipt of the request. An expedited decision de- cision may involve admissions, continued stay, or other healthcare services. For additional information informa- tion regarding the expedited decision process, or to request an expedited decision be made for a particular particu- lar issue, please contact Customer Service.

Medical Services. The Member, a designated representative, or a provider on behalf of the Member, may contact the Customer Service Department by telephone, Blue Shield will acknowledge receipt of a grievance within five calendar days. Grievances are resolved within 30 days. The grievance system allows Subscribers to file grievances for at least 180 days following any incident or action that is the subject of the Member’s dissatisfaction. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the request. An expedited decision may involve admissions, continued stay, or other healthcare services. For additional information regarding the expedited decision process, or to request an expedited decision be made for a particular issue, please contact Customer Service. letter, or online to request a review of an initial determination concerning a claim or service. Members may contact the plan at the telephone number as noted on the back page of this Evidence of Coverage and Health Service Agreement. If the telephone inquiry to Customer Service does not resolve the question or issue to the Member’s satisfaction, the Member may request a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate a grievance by submitting a letter or a completed “Grievance Form”. The Member may request this Form from Customer Service. The completed form should be submitted to Customer Service Appeals and Grievance, P.O. Box 5588, El Dorado Hills, CA 95762-0011. The Member may also submit the grievance online by visiting xxx.xxxxxxxxxxxx.xxx. Blue Shield will acknowledge receipt of a grievance within five calendar days. Grievances are resolved within 30 days. The grievance system allows Subscribers to file grievances for at least 180 days following any incident or action that is the subject of the Member’s dissatisfaction. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the request. An expedited decision may involve admissions, continued stay, or other healthcare services. For additional information regarding the expedited decision process, or to request an expedited decision be made for a particular issue, please contact Customer Service.