Loading...Loading...Whether you need help with an explanation of benefits (EOB) statement or disagree with a decision we’ve made about your coverage, benefits or services, you have options to get your questions answered. Knowing when to call our Customer Service team versus filing an appeal can save you lots of time and paperwork.
When we make a decision about what services we’ll cover or how we'll pay for them, we let you know by sending you an EOB statement or a letter regarding your authorization request. If you want us to reconsider our decision, you or an authorized representative may file an appeal about the following denials:
In many cases, you can get your questions answered quickly when you call our Customer Service team. Here are some common scenarios to help guide you.
Already a member? Sign in to chat with our Customer Service team.
Scenario | Action |
|---|---|
You don’t recognize the provider or the treatment described on your EOB statement. | Contact Customer Service |
You don’t know why your claim was denied or there’s a balance due. | Contact Customer Service |
Your claim was denied because additional information is needed. For example, your EOB statement may say your claim was denied for an incident report or other accident-related information, such as a personal injury protection (PIP) ledger. | Contact Customer Service |
Your provider is in network, but your claim was denied stating that the provider is non-participating. You disagree. | |
Your vitamin D test should be covered, but you were billed for it. You disagree. | File an appeal and include medical records when possible |
Your office visit (e.g., colonoscopy, lab test) should be covered under your preventive care benefit, but you’re being billed for it. You disagree. | File an appeal and include medical records when possible |
Your pre-authorization request was denied as “not medically necessary.” You disagree. | File an appeal and include medical records when possible |