There are three types of appeals in this category:
If you submit a medical, dental, vision or audio claim for payment and the claim is denied in whole or partially, you also have to right to appeal the denial.
Preauthorization may be required for a procedure or inpatient hospital stay. If the treatment is not certified, you have the right to appeal.
Preauthorization may be required for some prescription medication. If your request for prior authorization is denied, you can make your appeal to the Prescription Benefits Manager.
Generally, the appeal must be submitted within 180 days of the denial or non-certification. Refer to the section of the Plan Booklet entitled ‘If a Claim is Denied’ for more information on the appeals process. The Policy on Appeal of Denied Claims Involving Medical Necessity on this site also contains information about appealing a denied claim. Click here for appeal forms.