Time frames for responding to appealed claims


Health claim processing activity	Time frame
Claimant Appeal of Adverse Determination (Denial or Reduction)	180 calendar days
Plan Decision or Appeal	60 calendar days

EyeMed Vision Care has been determined to belong to the post service claims category. If a claim for benefits is denied, EyeMed Vision Care will notify the member in writing of the specific reasons for the denial. The member may request a full review by EyeMed Vision Care within 180 days of the date of a denial. The member's written letter of appeal should include the following:

The applicable claim number or a copy of the EyeMed Vision Care denial information or Explanation of Benefits, if applicable

The item of your vision coverage that you feel was misinterpreted or inaccurately applied

Additional information from your eye care provider that will assist EyeMed Vision Care in completing its review your appeal, such as documents, records, questions or comments

The appeal should be mailed to the following address:

EyeMed Vision Care, L.L.C.
Attn: Quality Assurance Dept.
4000 Luxottica Place
Mason, Ohio 45040

EyeMed Vision Care will review your appeal for benefits and notify you in writing of its decision, as well as the reasons for the decision, with reference to specific plan provisions.