Blue Cross Blue Shield (BCBS Association and FEP Blue): insurance claim denied

Appeal with your local Blue plan (address on the EOB). FEP members ask the Local Plan to reconsider within 6 months, then ask OPM.

ACredibility A · last verified 2026-10-12 · 94% official or government sources

What does this mean?

Grade A (high: almost everything comes from official pages read directly). 94% of 18 sources are the organization's own pages or government sites.

All Blue Cross Blue Shield (BCBS Association and FEP Blue) contacts Open in the interactive directory JSON

Collect

EOB
denial letter
member ID card
physician letters
bills
medical records
the brochure provisions you rely on

Steps

Find which Blue company handles your plan. Use the number on the back of the ID card. FEP members can pick their state on the FEP Blue contact page.
FormFEP Blue contact page (select your state to find the local BCBS company that handles your claims)
Ask the plan for the claim file. FEP members can call customer service or write to the EOB address to review and copy relevant materials free of charge.
PhoneFEP Blue (Federal Employee Program) National Information Center +1-800-411-2583
FEP members write to the Local Plan within 6 months of the decision. Explain why the decision is wrong and cite the Service Benefit Plan brochure provisions. Other Blue members follow the appeal instructions on their denial letter.
FormFEP Blue dispute a claim (disputed claims process)
FEP members who still disagree write to OPM within 90 days of the letter that upholds the denial.
MailOPM review of a disputed FEHB claim (after the Local Plan reconsideration) United States Office of Personnel Management, Health Care and Insurance, Federal Employee Insurance Operations, Health Insurance 1, Room 3425, 1900 E Street, N.W., Washington, DC 20415-3610
Non-FEP members ask for external review after the final internal denial, through the state insurance department (fully insured plans) or the plan's process; employer self-funded plan members can contact the Department of Labor.
RegulatorU.S. Department of Labor, Employee Benefits Security Administration +1-866-444-3272

More contacts for this issue

OnlineFEP Blue view claims and statements Sign-in required

Facts you can cite

Deadline
For FEP (FEHB and PSHB) post-service claims, write to the Plan within 6 months of its decision. The Plan has 30 days to pay, maintain its denial or ask for more information; requested information is due within 60 days.
Source: fepblue.org, verified 2026-10-12
Deadline
FEP members who still disagree must write to OPM within 90 days of the Plan letter that upholds the denial, or within 120 days of their first letter if the Plan did not answer within 30 days. OPM issues a final decision or status update within 60 days.
Source: fepblue.org, verified 2026-10-12
Deadline
For an urgent FEP pre-service claim, request reconsideration within 6 months of the initial decision; the Plan notifies you of its decision within 72 hours after it receives the request. Verbal or electronic requests may be used for expedited review.
Source: fepblue.org, verified 2026-10-12
Process
FEP members can review and copy relevant claim materials free of charge, including expert reviews, by calling customer service or writing to the address on the EOB.
Source: fepblue.org, verified 2026-10-12
Deadline
After OPM's decision, an FEP member may sue in Federal court only by December 31 of the third year after the year of the service or denial. This deadline cannot be extended.
Source: fepblue.org, verified 2026-10-12

Tips

Company tip
The Blue Cross Blue Shield Association does not handle member claims. Each Blue plan is a separate company; Anthem plans, for example, describe themselves as independent licensees of the Blue Cross Blue Shield Association. Contact the plan named on the member ID card.
Source: anthembluecross.com, verified 2026-10-12
Company tip
FEP Blue says questions about claims, prior approval or care management go to your local BCBS company, which you find by selecting your state on the FEP Blue contact page.
Source: fepblue.org, verified 2026-10-12

Rules in force

ACA internal appeals and external review for health coverage
45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)
After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.
Source: law.cornell.edu, verified 2026-10-12
10 citable points
- Deadline
  "You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied."
  Source: healthcare.gov, verified 2026-10-12
- Deadline
  The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.
  Source: healthcare.gov, verified 2026-10-12
- Deadline
  For urgent care claims, a group health plan must decide an appeal "not later than 72 hours after receipt of the claimant's request for review".
  Source: law.cornell.edu, verified 2026-10-12
- Process
  In urgent situations, "You may file an internal appeal and an external review request at the same time."
  Source: healthcare.gov, verified 2026-10-12
- Policy
  Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.
  Source: law.cornell.edu, verified 2026-10-12
- Deadline
  An external review must be requested within "4 months after the date you receive a notice or final determination" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.
  Source: healthcare.gov, verified 2026-10-12
- Policy
  The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.
  Source: healthcare.gov, verified 2026-10-12
- Policy
  If the plan fails to strictly follow the internal claims and appeals requirements, the claimant "is deemed to have exhausted the internal claims and appeals process", subject to a de minimis exception.
  Source: law.cornell.edu, verified 2026-10-12
- Limit
  These internal appeal and external review requirements generally do not apply to grandfathered plans.
  Source: law.cornell.edu, verified 2026-10-12
- Contact
  For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.
  Source: healthcare.gov, verified 2026-10-12
ERISA claims procedure timelines for employer benefit plans
29 CFR 2560.503-1
Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.
Source: law.cornell.edu, verified 2026-10-12
7 citable points
- Deadline
  Group health plan initial decisions: urgent care claims "not later than 72 hours after receipt of the claim by the plan"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims "not later than 30 days after receipt of the claim", with one extension of up to 15 days.
  Source: law.cornell.edu, verified 2026-10-12
- Deadline
  Disability claims: notice of decision "not later than 45 days after receipt of the claim by the plan", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.
  Source: law.cornell.edu, verified 2026-10-12
- Deadline
  Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have "at least 60 days following receipt of a notification" of the adverse determination.
  Source: law.cornell.edu, verified 2026-10-12
- Deadline
  Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).
  Source: law.cornell.edu, verified 2026-10-12
- Deadline
  Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.
  Source: law.cornell.edu, verified 2026-10-12
- Policy
  On appeal, the plan must provide, "upon request and free of charge, reasonable access to, and copies of, all documents" relevant to the claim.
  Source: law.cornell.edu, verified 2026-10-12
- Policy
  If the plan fails to establish or follow these claims procedures, "a claimant shall be deemed to have exhausted the administrative remedies available under the plan" and may bring a civil action under ERISA section 502(a).
  Source: law.cornell.edu, verified 2026-10-12

If that fails, escalate

Go up one step at a time. Keep the reference numbers and dates from each contact.

Customer service
MailOPM review of a disputed FEHB claim (after the Local Plan reconsideration) United States Office of Personnel Management, Health Care and Insurance, Federal Employee Insurance Operations, Health Insurance 1, Room 3425, 1900 E Street, N.W., Washington, DC 20415-3610
PhoneFEP Blue overseas customer service (FEHB), from the U.S., Puerto Rico and U.S. Virgin Islands +1-888-999-9862
Call the number on the back of the member ID card. That is your local Blue company, an independent licensee of the Blue Cross Blue Shield Association.
Written complaint
FormFEP Blue dispute a claim (disputed claims process)
Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM.
Federal regulator
MailOPM review of a disputed FEHB claim (after the Local Plan reconsideration) United States Office of Personnel Management, Health Care and Insurance, Federal Employee Insurance Operations, Health Insurance 1, Room 3425, 1900 E Street, N.W., Washington, DC 20415-3610
FEP members only: OPM review is the external step for federal employee plans.
State agency
Your state’s insurance department. Find it in the list of state agencies (also as JSON: states/<code>.json, for example states/ny.json).
External review for fully insured non-federal plans; complaint to the state.
Federal regulator
RegulatorU.S. Department of Labor, Employee Benefits Security Administration +1-866-444-3272
Employer self-funded (ERISA) plans administered by a Blue plan.
Federal regulator
RegulatorCMS No Surprises Help Desk +1-800-985-3059
Surprise bills under the No Surprises Act.

Watch out

The Association has no member service line for claims. Each local Blue plan has its own numbers, portals and appeal addresses.
FEP online claim disputes need a MyBlue account.
FEP eligibility questions go to the agency payroll office, retirement system or OWCP, not to the Plan.

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