Blue cross blue shield appeals phone number

Resolve problems

Blue Cross Blue Shield of Michigan wants to make sure you're satisfied with the services you receive as a member. If you have a question or concern about how we processed your claim or request for benefits, contact customer service. You can find the number on the back of your Blue Cross ID card. It's also at the top right-hand corner of your Explanation of Benefit Payments statements.

Grievance and appeals process

If you were unable to resolve your concern through customer service, we have a formal grievance and appeals process. The length of time you have to file an appeal will depend on whether you're eligible for an appeal under a state or federal process.

Under either process, we won't charge you anything extra for filing a grievance or appeal. You may submit written materials or testimony to help us in our review at any step of the grievance or appeals process. You can use the Member Appeal Form (PDF) to submit your appeal. The form is optional. You can use it by itself or with a formal letter of appeal.

You can select someone to act on your behalf at any step of the grievance and appeals process, including your physician. Just fill out the Authorized Representative Form (PDF). This form gives your representative the permission to communicate with Blue Cross Blue Shield of Michigan on a one-time basis about your appeal.

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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© 2022 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

At Blue Cross and Blue Shield of Illinois (BCSBIL), we take great pride in ensuring that you receive the care you need. But if you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal.

Grievance (Complaint):

A grievance is a complaint about any matter besides a service that has been denied, reduced or ended.

BCBSIL takes member complaints very seriously. We want to know what is wrong so we can make our services better. If you have a complaint about a provider or about the quality of care or services you have received, you should let us know right away. BCBSIL has special procedures in place to help members who file grievances. We will do our best to answer your questions or help to meet your concern. Filing a complaint will not change your health care services or your benefits coverage.

You may want to file a grievance if:

• Your provider or a BCBSIL employee did not respect your rights
• You had trouble getting an appointment with your provider in an reasonable amount of time
• You were unhappy with the care or treatment you received
• Your provider or a BCBSIL employee was rude to you
• Your provider or a BCBSIL employee did not respect your cultural needs or other special needs you may have

Appeals:

An appeal is a way for you to ask for someone to review our actions. You might want to file an appeal if BCBSIL:

• Does not approve a service your provider asks for
• Stops a service that was approved before
• Does not pay for a service your PCP or other provider asked for
• Does not give you the service in a timely manner
• Does not answer your appeal in a timely manner
• Does not approve a service for you because it was not in our network

If BCBSIL decides that a requested service cannot be approved, or if a service is reduced, stopped or ended, you will get a “Notice of Action” letter from us. You must file your appeal within 60 calendar days from the date on the Notice of Action letter. This letter will tell you the following:

• What action was taken and the reason for it
• Your right to file an appeal and how to do it
• Your right to ask for a State Fair Hearing and how to do it
• Your right in some circumstances to ask for an expedited appeal and how to do it
• Your right to ask to have benefits continue during your appeal, how to do it and when you may have to pay for the services

How to File an Appeal or Grievance:

There are two ways to file an appeal or grievance (complaint):

• Call Member Services at 1-877-860-2837. If you do not speak English, we can provide an interpreter at no cost to you. If you are hearing impaired, call the Illinois Relay at 711.
• Write to us at:

Blue Cross Community Health Plans
Attn: Grievance and Appeals Unit
P.O. Box 27838
Albuquerque, NM 87125-9705
Fax: 1-866-643-7069

After you file an appeal, we will call to tell you our decision and send you and your authorized representative a Decision Notice. If you disagree with the decision made on your appeal, you can ask for an External Review within 30 calendar days of the date on the Decision Notice. You may also ask for a State Fair Hearing Appeal within 120 calendar days of the date on the Decision Notice.

For more information regarding Appeals and Grievances, please see your Member Handbook.
 

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