You can file an appeal if you feel results are incorrect or your physician feels it is unreasonably difficult or medically inadvisable to meet the criteria due to a medical condition.
What timeframe do I have to file an appeal?
Appeals must be filed within 30 days of the date of your screening results report.
Who pays for the retesting that is submitted with the appeal?
Any retesting will be at the expense of the employee. If a wellness benefit is available through the current health plan and has not been exhausted, the retesting cost may be covered by it.
What paperwork is needed to file an appeal?
A completed Appeal Application, with physician documentation and copies of any additional testing results that apply to the appeal.
What specific information does my physician need to provide?
If appealing result accuracy:
• Blood Pressure: The re-test done by your physician or
four readings taken within the past six months from your physician
• Cholesterol: Re-tested results from a certified laboratory
• BMI: Re-tested results from a qualified medical
professional
• Tobacco/nicotine: Retested results by a certified laboratory
• Glucose (if applicable): Re-tested results by a certified laboratory
If appealing results for medical reasons:
• Your physician should write a statement on the appeals form with an explanation why attempting to achieve the goals would be unreasonably difficult or medically inadvisable with supporting documentation attached as deemed necessary.
Where do I obtain an Appeal Application from?
An appeal application may be printed from www.benicompadvantage.com website, under Contact Information, Forms, BCA Appeal Application -here or from your Human Resources Representative; or by calling a Benicomp Advantage Wellness Coordinator at 1-866-222-0102. Please note, only one appeal per wellness criteria will be evaluated.
Where do I send the completed information?
You may either mail or fax the Appeal information to: BeniComp Advantage, Inc. ATTN: Appeals Department, 8310 Clinton Park Drive, Fort Wayne, IN 46825, FAX: (260)482-8991.
What happens next?
The BCA Appeals Department will review your appeal, update your information based on the physician’s documentation that was submitted, and follow up by letter if the appeal was approved, or email if your appeal was denied.
