How to File an Appeal
If you feel that a claim has been inappropriately denied, you (or your authorized representative) may request a review any time within 180 days of being notified that your claim was denied. Your written appeal should state the reasons that you feel your claim should not been denied. It should include any additional facts and/or documents that you feel support your claim. You will have the opportunity to submit comments and have them considered. Your appeal will be reviewed and decided by someone who was not previously involved with your claim. The decision regarding the review will be made no later than 60 days after you submit the appeal. If the decision on review affirms the initial denial, you will be furnished with a notice of adverse benefit determination on review setting forth:
- the specific reason(s) for the decision on review;
- the specific Plan provision(s) on which the decision is based;
- a statement of your right to review (on request and at no charge) relevant documents and other information;
- a description of any specific rule, guideline, protocol, or other similar criterion or a statement it will be provided free of charge to you upon request; and
- Please note that PEBB establishes the eligibility rules for participation in this plan. Eligibility appeals should be directed to PEBB.
If you DO NOT
appeal on time, you will lose your right to appeal.
NOTE: Failing to file your claim(s) by the end of the runout period can not be remedied by the appeal process.
Please send your appeal to:
BenefitHelp Solutions
FSA Appeals
PO Box 67230
Portland, OR 97268
Or fax to:
503-765-3554
1-877-277-7279
