An appeal is a written request to change a decision by Louisiana Blue.
You can submit an appeal or you can authorize a provider or other representative to appeal on your behalf. To be considered, it must be submitted within 180 days of the decision.
Note - Authorizing someone to appeal doesn’t allow LA Blue to talk to that person about your health information. To name a person to speak to us on your behalf, complete the Authorized Delegate Form.
To submit an appeal, follow these steps:
Download appropriate form based on the type of decision you are appealing:
Authorizations or claims denied as medically necessary or investigational- Complete a Medical Appeal Request Form.
Any other decision- Complete an Administrative Appeal Request Form.
Complete the form. If a representative is appealing for you, complete and sign the appropriate Authorized Representative section.
Submit completed appeal form with supporting documentation to the address or fax number on the form.
The Appeals Department reviews and responds with a decision letter within 30 days of receiving the appeal. Instructions for next level appeal will be provided in the letter, if applicable.
