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September 26, 2016
Typically, when you receive medical services, your provider will bill your health plan (BCBSIL) before sending a bill to you. BCBSIL then reviews the services you received and determines which services are covered by your plan. Occasionally, claims may be denied after you’ve received services. This can happen for a variety of reasons, including:
Note: This is not a complete list. For more information, please see your benefits booklet.
The following steps may help you to avoid having your claim denied:
In addition to the above, your claims may be denied if you lose coverage after failing to pay your premium. For more information, see the What Happens if I Miss a Premium Payment? section.
If a claim is denied, you may be responsible for the cost of the services received. However, you also have the right to submit an appeal. An appeal is a way to have that decision reviewed. These steps will help get you started:
Refer to your benefit plan materials or call the Customer Service number on the back of your ID card with questions about the appeal process and plan benefits available to you.
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