What is the process for appealing a denied claim?

The process for appealing a denied claim with Horizon BC/BS of New Jersey involves several steps that members should follow to ensure their appeal is handled appropriately. First, it is important for the member to carefully review the denial notice, which will include specific reasons for the denial as well as information on how to appeal. This notice often provides a time frame within which the appeal must be submitted, so adhering to that timeline is essential. Next, the member should gather all relevant documents that support their case. This may include any medical records, bills, and the original claim submission. It may also be useful to compile a clear explanation of why the member believes the claim should be approved, addressing the specific reasons outlined in the denial notice. Once the member has the necessary documentation, they will need to write a formal appeal letter. This letter should include personal information such as the member's name, identification number, and relevant details about the claim. It is also advisable to state clearly the request for a reconsideration of the claim and to attach all supporting documents. The appeal letter should be sent to the address specified in the denial notice. Some members might choose to submit their appeal electronically, depending on the options provided by Horizon BC/BS of New Jersey. After the appeal is submitted, the organization typically has a specified period in which to review and respond to the appeal. For additional details, including deadlines and specific submission guidelines, members may find it useful to visit the relevant section of Horizon BC/BS's website or consult their member handbook.