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Disputing a Claim

Subscribers can dispute claims if they believe their carrier has processed a claim incorrectly according the plan's Explanation of Benefits (EOB). The carrier will review the dispute to determine if there was in fact an error in processing.

 

  • Instructions on how to dispute a claim can be found on the insurance carrier's website, and on the Summary of Benefits and Coverage for the plan.
  • Subscribers can call the carrier's Member Services line for guidance on how to properly submit a dispute or grievance.

Claim disputes and appeals can take up to 30 days to be reviewed by the carrier's claims division, so it's not always a quick process. However, this will ensure that the claim is thoroughly reviewed and, if determined to be processed incorrectly, re-processed accurately.

 

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