Anthem Claim Dispute Form With Email In San Diego

State:
Multi-State
County:
San Diego
Control #:
US-00435BG
Format:
Word; 
Rich Text
Instant download

Description

The Anthem claim dispute form with email in San Diego is designed to facilitate the resolution of disputes between a creditor and debtor regarding a claimed financial obligation. This form emphasizes the importance of clear communication between parties, outlining the details of the dispute and the agreed-upon resolution terms. Key features include spaces to specify the creditor's and debtor's names and addresses, the agreed payment amount, and a detailed description of the claims being discharged. Users should complete the form by entering accurate information in the designated fields, ensuring that all claims and denials are explicitly stated to avoid future misunderstandings. The form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants engaged in debt resolution, providing a structured way to formalize agreements and protect their clients’ interests. By using this form, legal professionals can help ensure that their clients have clear, legally binding documentation of their agreements. Overall, the Anthem claim dispute form simplifies the negotiation process and helps mitigate future disputes by providing a clear record of the parties’ agreements.

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FAQ

The appeal must be received by Anthem Blue Cross (Anthem) within 365 days from the date on the notice of the letter advising of the action.

Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.

With the PPO, you can use any of the BCBS providers in all 50 states. They may not be directly contracted with the BS of CA, but as long as they participate with the BCBS in the state you see a provider in, they will file claims with that plan. Benefits would be covered at the in-network rates given that's the case.

When complete, please mail to: Attn: Grievance and Appeals Department, Anthem Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007. For claim disputes, please use the Provider Dispute Resolution form. This information is part of the permanent record. Write clearly and legibly.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Effective January 1, 2024, Anthem Blue Cross (Anthem) will exit 14 counties listed here: Alameda, Butte, Colusa, Contra, Costa Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, and Yuba.

Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

Anthem Blue Cross is the trade name of In California: Blue Cross of California, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.

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Anthem Claim Dispute Form With Email In San Diego