93 internal appeal process. You or your authorized representative may request it orally or in writing. All necessary information, including our decision, can be sent between us and you by telephone, facsimile or other similar method. To proceed with an Expe dited External Review, you or your authorized representative must contact us at the number shown on your identification card and provide at least the following information: • the identity of the claimant; • The date (s) of the medical service; • the specific medical condition or symptom; • the provider’s name; • the service or supply for which approval of benefits was sought; and • any reasons why the appeal should be processed on a more expedited basis. All other requests for External Review should be submitted in writing unless we determine that it is not reasonable to require a written statement . Such requests should be submitted by you or your authorized representative to: Anthem Blue Cross and Blue Shield, ATTN: Appeals, P.O. Box 105568; Atlanta, GA 30348 - 5568. You must include Your Member Identification Number when submitting an appeal. This is not an additional step that you must take in order to fulfill your appeal procedure obligations described above. Your decision to seek External Review will not affect your rights to any other benefits under this health care plan. There is no charg e for you to initiate an independent External Review. The External Review decision is final and binding on all parties except for any relief available through applicable state laws or ERISA. Requirement to file an Appeal before filing a lawsuit No lawsuit or legal action of any kind related to a benefit decision may be filed by you in a court of law or in any other forum, unless it is commenced within one year of the Plan's final decision on the claim or other request for benefits. If the Plan decides an appeal is untimely, the Plan's decision on the claim or other request for benefits from which the appeal was taken shall be considered the Plan’s final decision, and the one - year period in which a lawsuit or legal action must be brou ght shall run from the date of that final decision, not the date on which Anthem decided the appeal was untimely. You must exhaust the internal appeals procedure, but not including any voluntary level of appeal, before filing a lawsuit or taking other legal action of any kind against the Plan. If your health benefit plan is sponsored by your employer and subject to the Employee Retirement Income Security Act of 1974 (ERISA) and your grievance or appeal as described above results in an adverse benefit determination, you have a right to bring a civil action under Section 502(a) of ERISA within one year of the appeal de cision. We reserve the right to modify the policies, procedures and timeframes in this section upon further clarification from Department of Health and Human Services and Department of Labor.
Benefit Booklet: Plan 1 Page 93 Page 95