How to file an appeal

When Health Advantage denies a claim for benefits, the member receives a personal health statement (PHS) 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 a claim number), and date and provider of service.

Appeal forms

Want to appeal a denied claim? Complete and submit this form with any additional information, and your request will be reviewed:
Member Appeal Submission Form [pdf]

Designation of Authorized Appeal Representative [pdf]

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:
Internal Review Request

Mail the request to:
Appeals Coordinator
Health Advantage
P.O. Box 8069
Little Rock, AR 72203-8069