HealthChoice Medicare Supplement Plans With and Without Part D
Grievance and Appeals Summary for Health Benefits
If your health claim was denied in whole or in part for any reason, you have the right to have that claim reviewed. Requests for review of your denied claim, along with any additional information you wish to provide, must be submitted in writing to:
Medical Claims Review
PO Box 24870
Oklahoma City, OK 73124-0870
or call 1-405-416-1800 or toll-free 1-800-782-5218
TDD users call 1-405-416-1525 or toll-free 1-800-941-2160
If, after a claim review, your claim remains denied, you may appeal that decision to the Grievance Panel. You may submit a request for a Grievance Panel hearing and represent yourself in these proceedings. If you are unable to submit a request for a Grievance Panel hearing yourself, only attorneys licensed to practice in Oklahoma are permitted to submit your hearing request for you or to represent you through the hearing process [75 O.S. Section 310(5)]. The Grievance Panel is an independent review group as established by statute 74 O.S. Section 1306(6).
All requests for hearings must be filed within one year of the date you are notified of the denial of a claim, benefit, or coverage. All medical claim reviews and final decisions of the Grievance Panel are made as quickly as possible. After exhausting the claim review and grievance procedures, you may pursue an appeal in Oklahoma District Court.
For more information contact:
The Legal Grievance Department
3545 NW 58th Street, Ste 110
Oklahoma City, OK 73112
You can also contact the Grievance Department by calling 1-405-717-8701 or toll-free
1-800-543-6044. TDD users call 1-405-949-2281, or toll-free 1-866-447-0436.