How Will I Be Billed for Medical Services? What If a Medical Service or a Claim Is The chart below gives examples of medical services Denied? What Are My Appeal Rights? that require the attention of a physician who may send a When a claim for bene昀椀ts or service denial occurs separate bill for payment. under the FMOLHS Health Plan, the member receives an explanation of bene昀椀ts (EOB) or service denial letter YOU WILL ALSO RECEIVE IF YOU HAVE: A BILL FROM: explaining the reason for the denial. The member has the right to 昀椀le an appeal to request a review of the denial. X-rays The radiologist The appeal should include policy holder name, health Certain lab tests The pathologist plan ID number, patient name, details regarding the Surgery The anesthesiologist & surgeon claim/service being appealed (such as a claim number), Visit by your personal physician Your personal physician and date and provider of service. For full details, please EKG Cardiologist see the Grievances and Appeals Process in the FMOLHS Health Plan Document posted on your facility intranet. Please note for the PPO Plan: If you have a procedure You must 昀椀le an appeal within 180 days after you have performed at an FMOLHS facility, your provider may or been noti昀椀ed of the denial of bene昀椀ts. may not be a FMOLHS Network Tier 1 provider. If the Send requests for review of a denial of bene昀椀ts by provider is not a FMOLHS Network Tier 1 provider, but mail to: is an in-network provider, you will receive a separate bill Blue Cross Blue Shield from the provider for the services performed and the Columbia Service Center provider will be paid at the Tier 2 bene昀椀t level. Attention: Appeals Coordinator AX-830 For example: if you have elected the PPO Plan (80% P.O. Box 100121 FMOLHS Network Tier 1 / 70% Preferred Provider Network Columbia, SC 29202-3121 Tier 2) you would be responsible for 30% of the in-network anesthesiologist’s bill after you have met your deductible. How Do I View My Medical Claims Online? To register for Blue Cross Blue Shield Online Services, after you receive your new medical ID card visit www.MyHealthToolkitLA.com/links/FMOLHS. You will need your medical ID card to register. » Select Register Now » Select Register » Follow the steps given to register www.MyHealthToolKitLA.com/links/FMOLHS allows you to: » View medical claims » View or print explanations of bene昀椀ts » View, request or print an ID card » Find a network provider 16