Medical Appeals - Argus Bermuda
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At Argus, we are committed to providing comprehensive coverage and exceptional service to our members. If you believe a claim or pre-authorisation decision should be reconsidered, you have the right to appeal.
Please follow the below steps to ensure your concerns are addressed:
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1. Review Your Benefits
Before filing a formal appeal, we encourage you to review your Explanation of Benefits (EOB) and policy details to better understand the reason behind the decision. You can review your EOB using our convenient online member portal, Argus Vantage, or you can contact us at (441) 298-0888 for a copy.
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2. Request for Reconsideration
If you believe an error was made, or have additional information, you may request a review of the decision. To submit any additional relevant documentation (e.g., medical records, provider’s statement), please email argusclaims@argus.bm.
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3. Filing a Formal Appeal
If the decision remains unchanged after your 'Request for Consideration', you have the right to file a formal appeal. Appeals must be submitted within 12 months of the original decision, giving you time to gather any necessary documentation. Your appeal will receive a thorough and fair review by our experienced claims department and medical team.
How to Submit:
Submit your appeal by email to argusclaims@argus.bm.
Please include:
- a detailed explanation of why the decision should be reversed
- any relevant medical documentation or provider statements
We will acknowledge a request within two business days and provide a formal response within 10 business days. You have the right to request copies of all documents related to the decision.