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We will identify for you the medical or vocational experts whose advice we obtained in connection with the initial decision. We will provide this information sufficiently in advance of the date by which we are required to provide you with our reconsideration decision to allow you reasonable opportunity to respond prior to that date.

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We will also provide you, free of charge and in a timely manner, with any new rationale for our claim decision.

We are required to provide you, free of charge and in a timely manner, with any new or additional evidence considered, relied upon, or generated by us or at our direction in connection with your claim. To make your request, please contact our Customer Service Department by writing Rural Carrier Benefit Plan, PO Box 14079 Lexington, KY 40512-4079 or calling 1-80. To help you prepare your appeal, you may arrange with us to review and copy, free of charge, all relevant materials and Plan documents under our control relating to your claim, including those that involve any expert review(s) of your claim. You or your authorized representative have the right to ask us to reconsider our claim decision as described in Section 8 of the Plan brochure. In such cases, the period for making the determination will be delayed. If the information we need to make a decision on your claim is not included with your claim, we may request an extension including a request for the specific information. However, we are allotted 72 hours to make a decision on urgent care claims if necessary.Īny time periods for benefit or appeal determinations in the brochure begin at the time a claim for benefits or appeal is filed in accordance with these claims procedures, without regard to whether we receive all information necessary to process a claim. We will notify you of our decision on an urgent care claim or reconsideration of an urgent care claim decision as soon as possible and usually within 24 hours as explained in Sections 7 and 8 of your Plan brochure.

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Section 7 of your Plan brochure explains how to file a claim with us and explains four different claim categories: urgent care claims concurrent care claims pre-service claims, prior approval, or required referral and post-service claims. Note: If anyone other than yourself wishes to file a disputed claim on your behalf with OPM, such as medical providers, that representative must include a copy of your specific written consent with the review request. Note: If you want OPM to review more than one claim, you must clearly identify which documents apply to which claim. United States Office of Personnel Management,ġ900 E Street, NW, Washington, DC 20415-3610. In such cases, the period for making the determination will be delayed from the date the notification is sent until the date on which you respond with the necessary information. You may immediately appeal to OPM if we fail to respond in any way to your request for reconsideration 30 days after the receipt of a timely-filed request from you. See below for more information on your rights under the disputed claims process. Office of Personnel Management (OPM) of our reconsideration decision for your claim. Section 8 of your Plan brochure explains your rights to ask us to reconsider our claim decision and how to seek review by the U.S. Information on Claims Appeals to the Office of Personnel Management

Aetna medicare advantage timely filing limit 2021