Active Health & Welfare – Appeals

If your claim is denied in whole or in part, or if you disagree with the decision made on a claim, you may ask for a review. Your request for review must be made in writing; state the reason(s) for disputing the denial; be accompanied by any pertinent material not already furnished to the Plan; and submitted within 180 days after you receive notice of denial (90 days for Death).

The following describes how to make appeals involving an adverse determination:

Urgent Care Claim: Call Anthem Blue Cross at (800) 274-7767 or MHN at (800) 748-2559 (depending on which organization made the determination).

Pre-Service Claim: Call Anthem Blue Cross at (800) 274-7767 or MHN at (800) 748-2559 (depending on which organization made the determination).

Post Service Claim: Submit to the Trust Fund Office at HS&BA:

HS&BA
4160 Dublin Blvd., Suite 400
Dublin, CA 94568

or FAX To (925) 588-7121.

Concurrent Claim: send to Anthem Blue Cross, MHN or the Trust Fund Office, depending on which organization made the adverse determination.

Burial Benefit Claim: Submit to the Trust Fund Office.  (Same as Post Service Claim address.)

Disability Claim: call the Trust Fund Office at (800) 635-3105.

Failure to file an appeal that meets all of these criteria will constitute a waiver of your right to a review of the denial of your Claim.

Review Process

You have the right to submit comments, documents, records and other information in support of your Claim for benefits. Upon written request and free of charge you will be provided with reasonable access to and copies of all documents, records and other information relevant to your Claim.  Upon request, you will be provided with the identification of medical or vocational experts, if any, that gave advice to the Plan on your Claim, without regard to whether their advice was relied upon in deciding your Claim.

IMPORTANT: This website does not contain all the rules & regulations regarding Appeals.  To obtain all information regarding appeals and appeals procedures, you must refer to the Plan Document / Summary Plan Description which is available in the Plan Documents section of this website.