Noblesville Schools Medical Plan 77 Section 6: Questions, Complaints and Appeals Section 6: Questions, Complaints and Appeals To resolve a question, complaint, or appeal, just follow these steps: What if You Have a Question? Call the telephone number shown on your ID card. Representatives are available to take your call during regular business hours, Monday through Friday. What if You Have a Complaint? Call the telephone number shown on your ID card. Representatives are available to take your call during regular business hours, Monday through Friday. If you would rather send your complaint to the Claims Administrator in writing, the representative can provide you with the address. If the representative cannot resolve the issue over the phone, he/she can help you prepare and submit a written complaint. The Claims Administrator will notify you of the decision regarding your complaint within 60 days of receiving it. How Do You Appeal a Claim Decision? Post-service Claims Post-service claims are claims filed for payment of Benefits after medical care has been received. Pre-service Requests for Benefits Pre-service requests for Benefits are requests that require prior authorization or benefit confirmation prior to receiving medical care. How to Request an Appeal If you disagree with a pre-service request for Benefits determination, post-service claim determination or a rescission of coverage determination, you can contact the Claims Administrator in writing to 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 first appeal request must be submitted to the Claims Administrator within 180 days after you receive the denial of a pre-service request for Benefits or the claim denial. For medical claims, the appeals address is: UnitedHealthcare - Appeals P.O. Box 30432 Salt Lake City, Utah 84130-0432