Denied by Anthem or Elevance Health? As a Blue Cross Blue Shield licensee operating in 14 states with 46 million members, Anthem is bound by the ACA, ERISA, and state-specific insurance laws. ClaimBack writes your appeal in 3 minutes.
Check My Claim Free →Takes 3 minutes · No login required · State DOI-ready letters
Anthem / Elevance Health is a Blue Cross Blue Shield licensee in California, Colorado, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, Wisconsin, and Connecticut. State law adds an extra layer of protection on top of federal rights.
Anthem operates under the jurisdiction of the Department of Insurance (DOI) in each of its 14 states. Each state DOI has its own unfair claims settlement practices laws that Anthem must follow. If Anthem denies your claim improperly, you can file a formal complaint with your state DOI. Many states have consumer assistance programs that can intervene on your behalf at no cost.
The Affordable Care Act mandates that all non-grandfathered Anthem plans provide an internal appeal process and access to independent external review. Anthem cannot deny coverage for essential health benefits without a clinically supported reason. The ACA also prohibits Anthem from imposing prior authorisation requirements that are more restrictive than evidence-based medical standards.
Anthem must acknowledge your appeal within 5 business days. Pre-service (prior auth) appeals must be decided within 15 days. Post-service (paid claims) appeals must be decided within 30 days. Urgent care appeals must be decided within 72 hours. After exhausting internal appeal, you may request external review — the independent reviewer has 45 days to issue a binding decision.
In all 14 Anthem states, you have the right to external review by an independent, state-approved review organisation. The external reviewer is prohibited from having any financial relationship with Anthem. External review decisions are legally binding on Anthem. In California specifically, the Department of Managed Health Care (DMHC) offers an Independent Medical Review (IMR) process with a strong consumer track record.
Three steps. No jargon. No legal degree required.
ClaimBack provides AI-assisted document drafting. We are not a law firm and do not provide legal advice.