How To File an Appeal

When Health Advantage denies a claim for benefits, the member receives an explanation of benefits (EOB) explaining the reason for the denial. The member has the right to file an appeal to request review of the denial of a claim in whole or in part.

An appeal must be submitted in writing. The appeal should include member name, health plan ID number, a reference to the claim being appealed (such as claim number), and date and provider of service.

Appeal Form

When To Submit an Appeal

You must file an appeal within 180 days after you have been notified of the denial of benefits.

Where To Submit an Appeal

Send requests for review of a denial of benefits in writing. Write on the envelope:
     Appeal Request
Send the request to:
     Member Response Coordinator
     Health Advantage
     P.O. Box 8069
     Little Rock, AR 72203-8069

Two Levels of Review

If the outcome of the first-level review is adverse, all Health Advantage members except Arkansas state and public school employees may appeal to the second level. The request for a second-level appeal must be made within 60 days after the member has been notified of the result of the first-level review. The member may appear in person or via teleconference during the second appeal. State and public school employees have a different appeals process, which is outlined on their state benefits site .

For Assistance

If you need assistance in filing an appeal, you may call 1-800-843-1329.