Claims Appeal

Claims Appeal Process

If a claim is denied, an Explanation of Benefits (EOB) is sent to the billing provider stating the reason/s of the denial. This will most often result in the provider billing the CampusCare member.

A Member or Provider may appeal the denied claim by submitting a detailed letter explaining the circumstances surrounding the accident/illness. A copy of the medical records pertaining to the accident/illness must also be submitted.

This information should be sent to:

CampusCare Appeals Unit
PO Box 8030
Westchester, IL 60154

Once the information is received, it will be reviewed by the CampusCare Medical Director. A letter will be sent to the Member or Provider who appealed the claim within 30 business days of receipt of the appeal.

** Please note that complete medical records must be sent with all claims appeals**

Please refer to the Grievance and Appeal Procedures section in the Certificate of Coverage for further instructions.