If your appeal is about a claim for benefits, you may request reasonable access to documents, records, and other information HMSA has about your claim. HMSA will provide this information to you at no charge or at a nominal cost.
Your appeal must include:
- Your name and HMSA subscriber number.
- The date of the non-covered service.
- The provider’s name.
- Any facts about your request.
- Why you believe the service should be covered.
To request an appeal, you or your authorized representative should write to the following address within one year of the date of the Explanation of Benefits:
P.O. Box 69437
Harrisburg, PA 17106-9437
The request may also be faxed to United Concordia® at 1-888-667-8388 toll-free.