{"id":"blue-cross-blue-shield","page":"https://escalate.alexgaoth.com/#/c/blue-cross-blue-shield","html":"https://escalate.alexgaoth.com/c/blue-cross-blue-shield/","generated":"2026-10-15","company":{"id":"blue-cross-blue-shield","name":"Blue Cross Blue Shield (BCBS Association and FEP Blue)","aliases":["bcbs","blue cross","blue shield","blue cross blue shield association","bcbsa","fep blue","fepblue","federal employee program","service benefit plan"],"sector":"insurance_health","website":"https://www.fepblue.org","account_url":"https://www.fepblue.org/pilot/login","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"find-local-plan","type":"web_form","label":"FEP Blue contact page (select your state to find the local BCBS company that handles your claims)","value":"https://www.fepblue.org/contact-us","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"fep-view-claims","type":"portal","label":"FEP Blue view claims and statements","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/view-claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.fepblue.org/","last_verified":"2026-10-12"},{"id":"fep-submit-claim","type":"web_form","label":"FEP Blue how to submit a claim","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/how-to-submit-claim","purposes":["claim_delay"],"source":"https://www.fepblue.org/","last_verified":"2026-10-12"},{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"id":"fep-overseas-phone","type":"phone","label":"FEP Blue overseas customer service (FEHB), from the U.S., Puerto Rico and U.S. Virgin Islands","value":"+1-888-999-9862","hours":"5 a.m.-6 p.m. Eastern time","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","note":"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."},{"rung":"written_complaint","channel":"fep-dispute-claim","note":"Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM."},{"rung":"regulator","channel":"opm-fehb-mail","note":"FEP members only: OPM review is the external step for federal employee plans."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for fully insured non-federal plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans administered by a Blue plan."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Appeal with your local Blue plan (address on the EOB). FEP members ask the Local Plan to reconsider within 6 months, then ask OPM.","evidence":["EOB","denial letter","member ID card","physician letters","bills","medical records","the brochure provisions you rely on"],"steps":[{"do":"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.","channel":"find-local-plan"},{"do":"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.","channel":"fep-member-phone"},{"do":"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.","channel":"fep-dispute-claim"},{"do":"FEP members who still disagree write to OPM within 90 days of the letter that upholds the denial.","channel":"opm-fehb-mail"},{"do":"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.","regulator":"dol-ebsa"}],"facts":[{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"process","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the bill with the EOB from your local Blue plan, then ask the plan and the provider to fix it.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB. FEP members can view claims online.","channel":"fep-view-claims"},{"do":"Call the number on the ID card (FEP members can use 1-800-411-BLUE) about a claim processed wrongly. Ask the provider to rebill to the EOB amount.","channel":"fep-member-phone"},{"do":"If it is not fixed, dispute the claim with the plan in writing.","channel":"fep-dispute-claim"}]},{"issue":"surprise_medical_bill","summary":"Compare the bill with the EOB, tell the local Blue plan and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility."},{"do":"Tell your local Blue plan (number on the ID card) and the provider that the bill may be a surprise bill.","channel":"fep-member-phone"},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"tips":[{"kind":"official","text":"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.","issues":["claim_denial","claim_delay","billing_error"],"source":"https://www.anthembluecross.com/","last_verified":"2026-10-12"},{"kind":"official","text":"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.","issues":["claim_denial","claim_delay"],"source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"known_blockers":["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."],"notes":"Blue Cross and Blue Shield plans are independent companies licensed by the Blue Cross Blue Shield Association. Members must use their own local Blue plan (named on the ID card) for claims and appeals. The Federal Employee Program (FEP Blue, the Service Benefit Plan) covers FEHB and Postal Service (PSHB) members; its external step is OPM review, not state external review. Separate registry entries cover Blue plans owned by Elevance Health (Anthem).","official_domains":["fepblue.org"],"security":{"known_scams":[{"kind":"policy","claim":"FEP Blue warns that \"free\" services that ask for your insurance card may not be free and could be fraudulently billed to you or your insurance company.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"FEP Blue warns members to avoid professionals who say they know how to bill for services the plan does not cover.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fep-fraud-hotline","type":"phone","label":"FEP Fraud Hotline (Blue Cross and Blue Shield Federal Employee Program)","value":"+1-800-337-8440","notes":"Other Blue members can also contact the Blue Cross and Blue Shield plan in their area.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"id":"opm-oig-fraud-hotline-mail","type":"mail","label":"U.S. Office of Personnel Management, Office of the Inspector General Fraud Hotline (by mail)","value":"United States Office of Personnel Management, Office of the Inspector General, Fraud Hotline, 1900 E Street, NW, Room 6400, Washington, DC 20415-1100","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"blue-cross-blue-shield","name":"Blue Cross Blue Shield (BCBS Association and FEP Blue)","sector":"insurance_health","website":"https://www.fepblue.org","account_url":"https://www.fepblue.org/pilot/login"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Appeal with your local Blue plan (address on the EOB). FEP members ask the Local Plan to reconsider within 6 months, then ask OPM.","evidence":["EOB","denial letter","member ID card","physician letters","bills","medical records","the brochure provisions you rely on"],"steps":[{"do":"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.","channel":{"id":"find-local-plan","type":"web_form","label":"FEP Blue contact page (select your state to find the local BCBS company that handles your claims)","value":"https://www.fepblue.org/contact-us","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}},{"do":"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.","channel":{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}},{"do":"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.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"do":"FEP members who still disagree write to OPM within 90 days of the letter that upholds the denial.","channel":{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"do":"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.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}}],"channels":[{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"find-local-plan","type":"web_form","label":"FEP Blue contact page (select your state to find the local BCBS company that handles your claims)","value":"https://www.fepblue.org/contact-us","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"fep-view-claims","type":"portal","label":"FEP Blue view claims and statements","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/view-claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.fepblue.org/","last_verified":"2026-10-12"},{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"id":"fep-overseas-phone","type":"phone","label":"FEP Blue overseas customer service (FEHB), from the U.S., Puerto Rico and U.S. Virgin Islands","value":"+1-888-999-9862","hours":"5 a.m.-6 p.m. Eastern time","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"facts":[{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"process","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"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":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"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.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"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.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"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.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"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.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"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":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"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.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"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).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[{"kind":"official","text":"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.","issues":["claim_denial","claim_delay","billing_error"],"source":"https://www.anthembluecross.com/","last_verified":"2026-10-12"},{"kind":"official","text":"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.","issues":["claim_denial","claim_delay"],"source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"escalation":[{"index":0,"rung":"frontline","note":"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.","candidate_channels":["opm-fehb-mail","fep-overseas-phone"]},{"index":1,"rung":"written_complaint","note":"Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":2,"rung":"regulator","note":"FEP members only: OPM review is the external step for federal employee plans.","channel":{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":3,"rung":"state_agency","note":"External review for fully insured non-federal plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":4,"rung":"regulator","note":"Employer self-funded (ERISA) plans administered by a Blue plan.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":5,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["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."],"security":{"official_domains":["fepblue.org"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"FEP Blue warns that \"free\" services that ask for your insurance card may not be free and could be fraudulently billed to you or your insurance company.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"FEP Blue warns members to avoid professionals who say they know how to bill for services the plan does not cover.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fep-fraud-hotline","type":"phone","label":"FEP Fraud Hotline (Blue Cross and Blue Shield Federal Employee Program)","value":"+1-800-337-8440","notes":"Other Blue members can also contact the Blue Cross and Blue Shield plan in their area.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"id":"opm-oig-fraud-hotline-mail","type":"mail","label":"U.S. Office of Personnel Management, Office of the Inspector General Fraud Hotline (by mail)","value":"United States Office of Personnel Management, Office of the Inspector General, Fraud Hotline, 1900 E Street, NW, Room 6400, Washington, DC 20415-1100","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.944,"sources":{"primary":17,"reference":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 18 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Blue Cross and Blue Shield plans are independent companies licensed by the Blue Cross Blue Shield Association. Members must use their own local Blue plan (named on the ID card) for claims and appeals. The Federal Employee Program (FEP Blue, the Service Benefit Plan) covers FEHB and Postal Service (PSHB) members; its external step is OPM review, not state external review. Separate registry entries cover Blue plans owned by Elevance Health (Anthem).","warnings":[]},"billing_error":{"company":{"id":"blue-cross-blue-shield","name":"Blue Cross Blue Shield (BCBS Association and FEP Blue)","sector":"insurance_health","website":"https://www.fepblue.org","account_url":"https://www.fepblue.org/pilot/login"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the bill with the EOB from your local Blue plan, then ask the plan and the provider to fix it.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB. FEP members can view claims online.","channel":{"id":"fep-view-claims","type":"portal","label":"FEP Blue view claims and statements","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/view-claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.fepblue.org/","last_verified":"2026-10-12"}},{"do":"Call the number on the ID card (FEP members can use 1-800-411-BLUE) about a claim processed wrongly. Ask the provider to rebill to the EOB amount.","channel":{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}},{"do":"If it is not fixed, dispute the claim with the plan in writing.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}}],"channels":[{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"fep-view-claims","type":"portal","label":"FEP Blue view claims and statements","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/view-claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.fepblue.org/","last_verified":"2026-10-12"},{"id":"fep-overseas-phone","type":"phone","label":"FEP Blue overseas customer service (FEHB), from the U.S., Puerto Rico and U.S. Virgin Islands","value":"+1-888-999-9862","hours":"5 a.m.-6 p.m. Eastern time","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[{"kind":"official","text":"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.","issues":["claim_denial","claim_delay","billing_error"],"source":"https://www.anthembluecross.com/","last_verified":"2026-10-12"}],"escalation":[{"index":0,"rung":"frontline","note":"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.","candidate_channels":["opm-fehb-mail","fep-overseas-phone"]},{"index":1,"rung":"written_complaint","note":"Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":2,"rung":"regulator","note":"FEP members only: OPM review is the external step for federal employee plans.","channel":{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":3,"rung":"state_agency","note":"External review for fully insured non-federal plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":4,"rung":"regulator","note":"Employer self-funded (ERISA) plans administered by a Blue plan.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":5,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["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."],"security":{"official_domains":["fepblue.org"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"FEP Blue warns that \"free\" services that ask for your insurance card may not be free and could be fraudulently billed to you or your insurance company.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"FEP Blue warns members to avoid professionals who say they know how to bill for services the plan does not cover.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fep-fraud-hotline","type":"phone","label":"FEP Fraud Hotline (Blue Cross and Blue Shield Federal Employee Program)","value":"+1-800-337-8440","notes":"Other Blue members can also contact the Blue Cross and Blue Shield plan in their area.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"id":"opm-oig-fraud-hotline-mail","type":"mail","label":"U.S. Office of Personnel Management, Office of the Inspector General Fraud Hotline (by mail)","value":"United States Office of Personnel Management, Office of the Inspector General, Fraud Hotline, 1900 E Street, NW, Room 6400, Washington, DC 20415-1100","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.944,"sources":{"primary":17,"reference":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 18 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Blue Cross and Blue Shield plans are independent companies licensed by the Blue Cross Blue Shield Association. Members must use their own local Blue plan (named on the ID card) for claims and appeals. The Federal Employee Program (FEP Blue, the Service Benefit Plan) covers FEHB and Postal Service (PSHB) members; its external step is OPM review, not state external review. Separate registry entries cover Blue plans owned by Elevance Health (Anthem).","warnings":[]},"surprise_medical_bill":{"company":{"id":"blue-cross-blue-shield","name":"Blue Cross Blue Shield (BCBS Association and FEP Blue)","sector":"insurance_health","website":"https://www.fepblue.org","account_url":"https://www.fepblue.org/pilot/login"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Compare the bill with the EOB, tell the local Blue plan and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility."},{"do":"Tell your local Blue plan (number on the ID card) and the provider that the bill may be a surprise bill.","channel":{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"fep-member-phone","type":"phone","label":"FEP Blue (Federal Employee Program) National Information Center","value":"+1-800-411-2583","hours":"Weekdays 8 a.m.-8 p.m. Eastern Time, excluding holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"notes":"1-800-411-BLUE. TTY users dial 711. Federal Employee Program members only; other Blue members call the number on their own ID card.","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"},{"id":"fep-overseas-phone","type":"phone","label":"FEP Blue overseas customer service (FEHB), from the U.S., Puerto Rico and U.S. Virgin Islands","value":"+1-888-999-9862","hours":"5 a.m.-6 p.m. Eastern time","source":"https://www.fepblue.org/contact-us","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"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.","candidate_channels":["opm-fehb-mail","fep-overseas-phone"]},{"index":1,"rung":"written_complaint","note":"Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":2,"rung":"regulator","note":"FEP members only: OPM review is the external step for federal employee plans.","channel":{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":3,"rung":"state_agency","note":"External review for fully insured non-federal plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":4,"rung":"regulator","note":"Employer self-funded (ERISA) plans administered by a Blue plan.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":5,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["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."],"security":{"official_domains":["fepblue.org"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"FEP Blue warns that \"free\" services that ask for your insurance card may not be free and could be fraudulently billed to you or your insurance company.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"FEP Blue warns members to avoid professionals who say they know how to bill for services the plan does not cover.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fep-fraud-hotline","type":"phone","label":"FEP Fraud Hotline (Blue Cross and Blue Shield Federal Employee Program)","value":"+1-800-337-8440","notes":"Other Blue members can also contact the Blue Cross and Blue Shield plan in their area.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"id":"opm-oig-fraud-hotline-mail","type":"mail","label":"U.S. Office of Personnel Management, Office of the Inspector General Fraud Hotline (by mail)","value":"United States Office of Personnel Management, Office of the Inspector General, Fraud Hotline, 1900 E Street, NW, Room 6400, Washington, DC 20415-1100","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.944,"sources":{"primary":17,"reference":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 18 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Blue Cross and Blue Shield plans are independent companies licensed by the Blue Cross Blue Shield Association. Members must use their own local Blue plan (named on the ID card) for claims and appeals. The Federal Employee Program (FEP Blue, the Service Benefit Plan) covers FEHB and Postal Service (PSHB) members; its external step is OPM review, not state external review. Separate registry entries cover Blue plans owned by Elevance Health (Anthem).","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"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.","candidate_channels":["opm-fehb-mail","fep-overseas-phone"]},{"index":1,"rung":"written_complaint","note":"Internal appeal with the local Blue plan. FEP members: written reconsideration request to the Local Plan, then OPM.","channel":{"id":"fep-dispute-claim","type":"web_form","label":"FEP Blue dispute a claim (disputed claims process)","value":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","purposes":["claim_denial"],"access":"open","notes":"Online filing of a medical claim dispute needs a MyBlue account. Written requests go to the Local Plan address on the EOB.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":2,"rung":"regulator","note":"FEP members only: OPM review is the external step for federal employee plans.","channel":{"id":"opm-fehb-mail","type":"mail","label":"OPM review of a disputed FEHB claim (after the Local Plan reconsideration)","value":"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","purposes":["claim_denial"],"notes":"OPM FEHB 1 phone 202-606-0727, 8 a.m.-5 p.m. ET. PSHB (Postal Service) members write to Postal Service Insurance Operations (PSIO), 1900 E Street, N.W., Room 3443, Washington, DC 20415-3610; phone 202-936-0002.","source":"https://www.fepblue.org/manage-your-health/manage-claims-records/dispute-claim","last_verified":"2026-10-12"}},{"index":3,"rung":"state_agency","note":"External review for fully insured non-federal plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":4,"rung":"regulator","note":"Employer self-funded (ERISA) plans administered by a Blue plan.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":5,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["fepblue.org"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"FEP Blue warns that \"free\" services that ask for your insurance card may not be free and could be fraudulently billed to you or your insurance company.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"FEP Blue warns members to avoid professionals who say they know how to bill for services the plan does not cover.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fep-fraud-hotline","type":"phone","label":"FEP Fraud Hotline (Blue Cross and Blue Shield Federal Employee Program)","value":"+1-800-337-8440","notes":"Other Blue members can also contact the Blue Cross and Blue Shield plan in their area.","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"},{"id":"opm-oig-fraud-hotline-mail","type":"mail","label":"U.S. Office of Personnel Management, Office of the Inspector General Fraud Hotline (by mail)","value":"United States Office of Personnel Management, Office of the Inspector General, Fraud Hotline, 1900 E Street, NW, Room 6400, Washington, DC 20415-1100","source":"https://www.fepblue.org/legal/healthcare-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.944,"sources":{"primary":17,"reference":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 18 sources are the organization's own pages or government sites.","dossier_last_verified":null},"dossier":null,"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}