Deadline for appeals

Is the deadline for appeals typical from the date of service or the date of the EOB?

I have Credence BCBS and I just have a claim denied due to lifetime benefit being met. This is for genetic testing during an amniocentesis that was performed on 2/7/24. I obtained prior authorization through Carelon. On 4/24 I receive the EOB stating it was denied because maximum lifetime benefits have been used for this contract (CARC: 35). I did the same test in 2021 for a previous pregnancy. The prior authorization did say it was subject to plan maximum or limitations. It never crossed my mind that there would be a limit since this testing is recommended for each pregnancy I have….

I called BCBS yesterday to ask about the lifetime maximum. The rep said that she didn’t see any limitations on this procedure in my plan and she resubmitted it for consideration. She said it could take 2 weeks to process. I just received the bill from the lab for $2600.

I am just wondering if the 180 days to appeal started on 2/7 or on 4/24.

submitted by /u/idlegrad
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