Getting Help With Eligibility & Claims

Getting Help With Benefits Eligibility & Claims

The plans have a review process that is followed whenever you submit a benefit claim or an eligibility claim. There are dedicated teams to assist you with both benefit and eligibility issues.

When you file a claim, the claims administrator reviews the claim and, in accordance with plan provisions, either approves or denies the claim (in whole or in part). The claims administrator will notify you of this action. In some situations, the plan may need additional time to process the claim (for example, if the plan needs additional information). In these cases, you’ll be notified of the extension and the additional information needed.

Getting Eligibility Help—Claims and Appeals

If you have an issue with your claim dealing with eligibility for you or a covered dependent, Claims and Appeals can help. Claims and Appeals is a special group of Your Benefits Resources representatives dedicated to assisting you with your eligibility claims issues. Call Your Benefits Resources at 1-877-BMC-4849 for assistance. Claims and Appeals will conduct an initial review and determination.

Getting Claims Help—Participant Advocacy Team

BMC Software wants you to get the most out of your health care benefits. The Participant Advocacy service is available to help you resolve any conflicts you may have with your medical, dental or health care/dependent care FSA claims and carriers.

What Is Participant Advocacy?

Participant Advocacy will help you with unresolved health plan access or claims issues. The Advocate Team will research your issue and work with your health plan to resolve it on your behalf.

The Advocate Team helps ensure that your issue is given the attention it deserves and is considered fairly. However, contacting the Advocate Team does not guarantee the resolution you want—the terms of the plan still apply.

The service is available to employees enrolled in medical, vision, prescription drug, mental health care, dental and the health care/dependent care FSA plans.

How Can I Reach the Advocacy Team?

Call the Participant Advocacy Team at 1-888-886-8734 between 7 a.m. and 6 p.m. weekdays. All calls are confidential.