As a reminder, it is necessary for a participating provider to obtain the
member’s consent to appeal on his or her behalf for services that are
classified as Cosmetic or Experimental/Investigational (E/I). The signed form
must be included with your appeal submission.
Independence recently added the Member Consent for Provider to File an Appeal on my Behalf
with Health Insurance Plan form to our website to streamline the
process for our providers and members.
Once you have completed the form, you can send it along with your appeal
to:
Member Appeals
P.O. Box 41820
Philadelphia, PA 19101-3652
Note: Appeals that do not include a signed member consent form
cannot be processed and will be returned to the provider to take further
action.
For more information, please call Customer Service at
1-800-ASK-BLUE.