I don’t agree with the way the plan paid my claim. What can I do?
If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process.
- Check your plans FEHB brochure to see if the service is covered, limited, or excluded.
- Review and follow the directions in the disputed claims section of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered.
If the plan again denies the claim, read the plans decision letter carefully. Then, check your plans brochure again. If you still disagree with the plans decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.