Fighting the Refusal of an FEHB Claim

You might have seen a time when you got into a dreadful quarrel over your health benefits plan. You wanted medical procedure coverage in the plan, and it was not there for your need. Fortunately, there is a method that would resolve such disagreements. If you disagree with your plan’s decision, you can and should ask them to consider it again. You can follow the procedure of writing to the Office of Personnel Management (OPM) mentioned in the plan’s brochure when you choose it. But if the plan still does not agree to the demands, you can and should write to OPM and request to take a review of the claim you have provided. Also, the information about writing an application to OPM is mentioned in the plan’s brochure. 

How does OPM respond to the queries?

OPM has a way of accepting requests. Therefore, write an appealing application that they would consider. Make sure you provide the necessary details. If they require no information besides what you have given, they will give their final decision in 60 days. If they need more information to confirm you or the plan, they will inform you by writing you back 14 days from the day you registered. Also, they will give you a phone number through which you can have an update regarding your claim status. If the decision is made in your favor, you do not need to worry and take a pause. But in case your claim has been rejected, you can file for it in Federal Court. You are free to do so. Furthermore, the best way to resolve your case early is by reading what is written on the brochure very carefully. Remember that your brochure is a contract. It is similar to any other agreement you make. 

How will your contract help you win the case?

When a dispute is seen, you need to stick to your contract to prove the validity of your point. Then, you will have to gather all the facts and support your argument. The better you do this, you will likely get a positive response for the reconsideration application. If this does not work as you want it to, you must go to OPM. It would be best if you had a logic that would counter the decision OPM has made for you. You could point out the mistakes or the vague language in the contract. It might allow you to get the help you want.

Remember one thing. If there is a particular medical procedure or a service that needs to be covered in the brochure and it is not covered (which is the last thing you would expect), the chance of getting a payment for it is zero. But other than that, your argument might be why it should get covered. It may be a huge help since it will add to the contract for the coming year, and many would benefit.

Contact Information:
Email: [email protected]
Phone: 9568933225

Bio:
Rick Viader is a Federal Retirement Consultant that uses proven strategies to help federal employees achieve their financial goals and make sure they receive all the benefits they worked so hard to achieve.

In helping federal employees, Rick has seen the need to offer retirement plan coaching where Human Resources departments either could not or were not able to assist. For almost 14 years, Rick has specialized in using federal government benefits and retirement systems to maximize retirement incomes.

His goals are to guide federal employees to achieve their financial goals while maximizing their retirement incomes.