128 Federal Notice Concurrent Care Claims If an on-going course of treatment was previously approved for a specific period of time or number of treatments, and your request to extend the treatment is an urgent request for Benefits as defined above, your request will be decided within 24 hours, provided your request is made at least 24 hours prior to the end of the approved treatment. The Claims Administrator will make a determination on your request for the extended treatment within 24 hours from receipt of your request. If your request for extended treatment is not made at least 24 hours prior to the end of the approved treatment, the request will be treated as an urgent request for Benefits and decided according to the timeframes described above. If an on-going course of treatment was previously approved for a specific period of time or number of treatments, and you request to extend treatment in a non-urgent circumstance, your request will be considered a new request and decided according to post-service or pre-service timeframes, whichever applies. Questions or Concerns about Benefit Determinations If you have a question or concern about a benefit determination, you may informally contact call the Claims Administrator at the telephone number on your ID card before requesting a formal appeal. If the representative cannot resolve the issue to your satisfaction over the phone, you may submit your question in writing. However, if you are not satisfied with a benefit determination as described above, you may appeal it as described below, without first informally contacting a representative. If you first informally contact the Claims Administrator and later wish to request a formal appeal in writing, you should again contact the Claims Administrator and request an appeal. If you request a formal appeal, a representative will provide you with the appropriate address. If you are appealing an urgent claim denial, please refer to Urgent Appeals that Require Immediate Action below and contact the Claims Administrator, immediately. How Do You Appeal a Claim Decision? If you disagree with a pre-service request for Benefits determination or post-service claim determination or a rescission of coverage determination after following the above steps, you can contact the Claims Administrator in writing to formally request an appeal. Your request for an appeal should include: • The patient's name and the identification number from the ID card. • The date(s) of medical service(s). • The provider's name. • The reason you believe the claim should be paid. • Any documentation or other written information to support your request for claim payment. Your denial of pre-service request for benefits or a first appeal request must be submitted to the Claims Administrator within 180 days after you receive the denial of pre-service request for benefits or a claim denial. Appeal Process A qualified individual who was not involved in the decision being appealed will be chosen to decide the appeal. If your appeal is related to clinical matters, the review will be done in consultation with a health care professional with expertise in the field, who was not involved in the prior determination. The Claims Administrator may consult with, or ask medical experts to take part in the appeal resolution process. You consent to this referral and the sharing of needed medical claim information. Upon request and free of charge, you have the right to reasonable access to and copies of all documents, records, and other information related to your claim for Benefits. If any new or additional evidence is relied upon or