At any time, you have the right to appoint someone to pursue the claim on your behalf. This can be a doctor, lawyer or a friend or relative. You must tell us in writing and give us the name, address and phone number where your appointee can be reached. If You Have A Complaint A complaint is an statement of discontent about a benefit or coverage decision or our customer service. The complaint process lets Customer Service quickly and informally correct errors, clarify decisions or benefits, or take steps to improve our service. We recommend, but don’t require, that you take advantage of this process when you’re not content with a benefit or coverage decision. If Customer Service finds that you need to submit your complaint as a formal appeal, a representative will tell you. When you have a complaint, call or write our Customer Service department. We’ll let you know when we’ve received your complaint. We may also ask for more information when needed. When we receive all needed information, we’ll review your complaint and respond as soon as possible, but never more than 30 calendar days. How To Appeal A Claims Decision An appeal is an oral or written request to reconsider 1) a decision on a complaint, or 2) a decision to deny, modify, reduce, or end payment or coverage. This includes admissions to and continued stays in a hospital or other facility. We must receive your appeal within 180 calendar days of the date you received notice of our decision. If you’re appealing a complaint decision, we must receive your appeal within 180 calendar days of the date we gave you that decision. Although we’ll accept an appeal made by phone to our Customer Service department, it’s a better idea to put appeals in writing so you can keep copies for your records. Please send all written appeals to the address shown on the back cover of this booklet. We will let you know when we receive your appeal. You have the right to give us comments, documents or other information to support your appeal. You can also ask to review documents relevant to your claim. Appeals Process Please call Customer Service if you have questions or need more information about our complaint or appeal process. The numbers are shown on the back cover of this booklet. The plan's standard appeals process has 2 levels of review. Appeal decisions are provided in writing. Level I The Level I Appeal panel will give you its decision within 30 calendar days. This panel will include health care providers as needed. Persons involved in the initial decision will not be on the panel. If you don’t agree with the decision reached in our Level I review, you may ask us to perform a Level II review of your appeal. You may also send us more information to support your appeal. You must make your request for a Level II review no more than 60 calendar days after the date you receive our Level I decision. This time limit may be extended in the event you need to obtain further medical documentation, physician consultations or opinions, if you are in the hospital or are traveling, or for other reasonable cause not in your control. In no case shall the extension exceed 180 days. 11 Group Plan G/Age