Appeals

Internal Appeal

Anthem Appeal
There are two levels of appeal through Anthem. A first level appeal must be submitted in writing to Anthem within 180 days of the date of the original notice. If a second level appeal is needed, it must be submitted in writing to Anthem within 60 days of the date of the first level decision. In most cases, the member must exhaust both levels of appeal before moving to an external review.

Medical appeals must include the following:

• Patient information: Name, member ID, address, phone number and date of birth; and
• Claim information: date(s) of service, your doctor’s name/address/phone number; and
• Any other information about your claim that you think is important.

A written response will be issued within 20 business days from the date the medical plan receives the appeal request. If more time for review is required for reasons beyond the plan's control, the plan must notify the member within 20 days of the appeal request. The notification must explain the reason for the delay and may request additional information.

If you need a decision fast, you may be eligible for an “expedited appeal” and get an answer in about 72 hours. Use this option if:

• Your life or health is in danger.
• In your doctor’s opinion, your pain can’t be adequately controlled while you wait.
• You had emergency services but haven’t been discharged from the facility.

To request an expedited appeal, call Anthem or submit the appeal to the address provided for appeals.

UnitedHealthcare Medicare Advantage Appeal
UnitedHealthcare Medicare Advantage Plan appeals concerning claims and benefits are managed by UnitedHealthcare in accordance with CMS rules.