SurgeryPlus

Appeal Process

• SurgeryPlus Appeal Process 
  To request a review or appeal the processing of claims for health care services, member must complete the following two forms and submit to the Statewide Benefits Office (SBO):

  • State of Delaware Authorization for Release of Protected Health Information Form 

  • Appeal Form and Checklist for Filing a Level III Appeal of Prior Denial to SBO 

• Highmark Delaware Appeal Process for non-Medicare Health Plans

• Aetna Appeal Process for CDH Gold and HMO Health Plans

• Non-Medicare Prescription Plan Appeal Process