Plan documents under our control relating to your claim, including those that involve anyĮxpert review(s) of your claim. Request, you may arrange with us to review and copy, free of charge, all relevant materials and You or your authorized representative have the right to ask us to reconsider our claim decisionĪs described in Section 8 of the Plan brochure. With knowledge of your medical condition may act as your authorized representative without
#Aetna timely filing for appeals professional#
However, for urgent care claims, a health care professional Such as medical providers, that representative must include a copy of your specific writtenĬonsent with the review request. Note: If anyone other than yourself wishes to file a disputed claim on your behalf with OPM, Note: If you want OPM to review more than one claim, you must clearly identify which Maintain the right to resubmit and pursue your claim and appeal through our claims andĪppeals process, set forth in your Plan brochure. If OPM rejects your request for immediate review on the basis that we met the standard, you You are entitled, upon written request, to an explanation of our basis for asserting that our United States Office of Personnel Management Information and 5) not part of a pattern or practice of non-compliance. We will be in “substantialĬompliance” if our failure or violation is 1) minor 2) non-prejudicial 3) attributable to goodĬause or matters beyond our control 4) in the context of an ongoing good faith exchange of With these rules, OPM may reject your immediate appeal. However, if OPM finds that we are in “substantial compliance” Violated our claims or appeals procedures, or that our procedures are deficient, you may Rules set forth under the Patient Protection and Affordable Care Act. Our claims and appeals process, set forth in Section 8 of the Plan brochure, is required to comply with See below for more information on your rights under the disputed claims process.
Office of Personnel Management (OPM) for review of our reconsideration decision for
#Aetna timely filing for appeals how to#
Section 8 of your Planīrochure explains your rights to ask us to reconsider our claim decision and how to appeal to Sections 3, 7 and 8 of the Plan brochure explain how to file a claim with us. Information on Claims and Appeals to the Office of Personnel Management
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