You or your health care provider can file an appeal if you have received an adverse benefit determination, meaning that you disagree with a health benefits related coverage or payment decision.
Generally, there is a two-step appeals process.
How to file an appeal
- Medical - Blue Cross Blue Shield of Texas (BCBS)
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First Level:
A request for appeal must be submitted within 180 days from receipt of notice of the initial adverse benefit determination.
Second Level:
If you do not agree with the first level appeal decision, you have 180 days from the date of your first level appeal denial to ask for a secondary appeal review.
By mail or fax, you must submit the same documentation filed during your first level appeal, as well as any new or additional information that may support your case.
Urgent Care Appeal
If your claim is urgent in nature, you or your provider can file an urgent appeal via phone or fax which will receive a response within 72 hours.
If both the 1st and 2nd level appeal have been denied you can learn more from BCBS about the External Review process.
Contact Information:
Medical Urgent Care Appeal Phone: 817-967-1412
Medical Urgent Care Appeal Fax: 817-967-6335
Address to mail Appeals: Blue Cross and Blue Shield of Texas, ATTN: Appeals Department, PO Box 660044, Dallas, TX 75266-0044
- Medical - DFW ConnectedCare
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First Level:
A request for appeal must be submitted within 180 days from receipt of notice of the initial adverse benefit determination.
Second Level:
If you do not agree with the first level appeal decision, you have 180 days from the date of your first level appeal denial to ask for a secondary appeal review.
By mail or fax, you must submit the same documentation filed during your first level appeal, as well as any new or additional information that may support your case.
- Medical - UMR
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First Level:
A request for appeal must be submitted within 180 days from receipt of notice of the initial adverse benefit determination.
Second Level:
If you do not agree with the first level appeal determination, you have 180 days from the date of your first level appeal decision to file a second level appeal.
By mail or fax, you must submit the same documentation filed during your first level appeal, as well as any new or additional information that may support your case.
Urgent Care Appeal
If your claim is urgent in nature, you or your provider can file an urgent appeal via phone or fax which will receive a response within 72 hours.
If both the 1st and 2nd level appeal have been denied you can learn more from UMR about the External Review process.
Contact Information:
Medical Urgent Care Appeal Phone: 877-826-9781
Medical Urgent Care Appeal Fax: 877-291-3248
- Medical - United Healthcare (UHC)
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First Level:
A request for appeal must be submitted within 180 days from receipt of notice of the initial adverse benefit determination.
Second Level:
If you do not agree with the first level appeal determination, you have 180 days from the date of your first level appeal decision to file a second level appeal.
By mail or fax, you must submit the same documentation filed during your first level appeal, as well as any new or additional information that may support your case.
Urgent Care Appeal
If your claim is urgent in nature, you or your provider can file an urgent appeal via phone or fax which will receive a response within 72 hours.
If both the 1st and 2nd level appeal have been denied you can learn more from UHC about the External Review process.
Contact Information:
Medical Urgent Care Appeal Phone: 800-955-8095 (Post 65 Retirees and TWA Pre 65 Retirees call 800-638-9599)
Medical Urgent Care Appeal Fax: 801-994-1083
Address to mail Appeals: UnitedHealthcare – Appeal Department, P.O. Box 30432, Salt Lake City, UT 84130-0432
- Prescription Drug - CVS Caremark
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First Level:
A request for appeal must be submitted within 180 days from receipt of notice of the initial adverse benefit determination.
Second Level:
If you do not agree with the first level appeal decision, you have 180 days from the date of your first level appeal denial to ask for a secondary appeal review.
By mail or fax, you must submit the same documentation filed during your first level appeal, as well as any new or additional information that may support your case.
Urgent Care Appeal
If your claim is urgent in nature, you or your provider can file an urgent appeal via phone or fax which will receive a response within 72 hours.
If both the 1st and 2nd level appeal have been denied you can learn more from CVS Caremark about the External Review process.
Contact Information:
Clinical appeal requests
CVS/Caremark Appeals Department MC109
P.O. Box 52084
Phoenix, AZ 85072-2084
Phone: 844-758-0767
Fax: 866-443-1172Urgent clinical appeal requests
Phone: 844-758-0767 - All other Appeals
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Visit the Forms Page for appeals related to administrative issues, dental, disability, Pilot LTD and second level medical appeals for which Blue Cross Blue Shield is the administrator.
