As a member of the PEBP CDHP, you have the right to voice complaints about the plan or submit appeals. You have the right to ask the Plan Administrator or its designees to reconsider a determination resulting in a denial (in whole or in part) for a service or treatment, or rescission of coverage (retroactive cancellation).

The CDHP Master Plan Document provides information regarding the terms, conditions, and administration of the benefits provided to participants. Beginning on page 100 of the document, information is provided on how a participant can appeal a decision made by either the PEBP Staff or the PEBP claims administrator(s).

Once you have received an (EOB) from Healthscope denying coverage, you will have 180 days to submit an appeal to the claims administrator. Appeals must be submitted in writing and should include the following:

• The name and social security number, or member identification number, of the Participant;
• A copy of the EOB and claim; and
• A detailed written explanation why the claim is being appealed.
• Information is mailed to the Claims Administrator:

  Healthscope
  P.O. Box 91603
  Lubbock, TX 79490-1603

  Express Scripts
  P.O. Box 66566
  St. Louis, MO 63166-6566

Failure to request a review in a timely manner will be deemed to be a waiver of any further right of review of appeal under the Plan unless the Plan Administrator determines that the failure was acceptable.

For a list of frequently asked questions, please refer to our FAQ.