Case Analysis Of Alice Hejl

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Alice Hejl had coverage under the Select Choice Individual Health insurance policy effective April 6, 2012. The policy terminated effective April 1, 2014. After a review of the concerns presented in Ms. Hejl’s inquiry to your office, we have determined claim number 407103033540C and 403501904091C we denied properly. Attached is a copy of the portion of Ms. Hejl’s policy that outlines the Claims Appeal Procedure, along with applicable time frames and the portion of her policy book that discuss Proof of Loss requirements. Ms. Hejl is submitting claims to BCBSTX outside of the timely filing requirement. Additionally, we’ve completed an audit (attached) of Ms. Hejl’s Medical claim history as requested and determined there was no error in Ms.

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