2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 8. The Disputed Claims Process
Page 118
Section 8. The Disputed Claims Process
Page 118
Note: If you have a serious or life-threatening condition (one that may cause permanent loss of bodily functions or death if not treated as soon as possible), and you did not indicate that your claim was a claim for urgent care, then call us at the customer service phone number on the back of your ID card. We will expedite our review (if we have not yet responded to your claim); or we will inform OPM so they can quickly review your claim on appeal. You may call OPM’s FEHB 1 at 202-606-0727 between 8 a.m. and 5 p.m. Eastern Time.
Please remember that we do not make decisions about Plan eligibility issues. For example, we do not determine whether you or a family member is covered under this Plan. You must raise eligibility issues with your agency personnel/payroll office if you are an employee, your retirement system if you are an annuitant, or the Office of Workers’ Compensation Programs if you are receiving Workers’ Compensation benefits.
Please remember that we do not make decisions about Plan eligibility issues. For example, we do not determine whether you or a family member is covered under this Plan. You must raise eligibility issues with your agency personnel/payroll office if you are an employee, your retirement system if you are an annuitant, or the Office of Workers’ Compensation Programs if you are receiving Workers’ Compensation benefits.