Appeal quizziz

Grievance

Appeal

Precertification

Yesh

knor

Appeal was not received

Second appeal level

Peer-to-peer review

Independent external review

Clinical

Grievance

Administrative

Hearing Aid claim denied as coverage is only available to a certain age

Orthotics denied as services did not meet Anthem's Medical Policy and Clinical Guidelines

Claim denied as services billed exceeds the benefit maximum of the plan

Cancelled

Overturned

Upheld

Fax

Mail

Phone call to a customer service representative

Subscriber complaining due to consistent long wait times in the provider's office.

Subscriber complaining that her doctor is performing malpractice.

subscriber complaining that his/her policy does not cover cosmetic procedures.

Claim denied due to timely filing.

Claim denied due to services are not billable based on the provider's fee schedule.

Claim denied due to medical necessity.

Upheld

Overturned

Cancelled

None of the above.