What is the process for appealing a denied claim?

When a claim is denied by Blue Cross and Blue Shield of Minnesota, the appeal process is designed to allow members to request a review of that decision. Initially, it is important for members to understand the specific reason for the denial, as this information will be critical when preparing the appeal. To begin the appeal process, the member must typically submit a written request for an appeal. This request should include pertinent details such as the member's name, policy number, and a clear statement indicating the desire to appeal the denied claim. It may also be beneficial to include any additional information or documentation that supports the claim, such as medical records, bills from healthcare providers, or statements outlining the necessity of the service. Once the appeal is submitted, Blue Cross and Blue Shield of Minnesota will review the claim and the relevant documents. The review process usually involves a team of professionals who may include medical experts who assess the medical necessity and appropriateness of the services rendered. The member may receive a written decision regarding the appeal within a specified period, often within a set number of days as outlined in the member handbook or policy documents. If the appeal is denied again, members usually have the right to pursue further steps, which might include requesting an external review by an independent entity. It is always advisable to refer to the specific policy documents and the Blue Cross MN website for detailed instructions, timelines, and any additional requirements regarding the appeal process. Members can also often find important contact information on the current web page to assist with their inquiries.