What is an appeal?

An appeal is a member's request for a review of a pre-service, urgent care or post-service claims that was initially denied by Blue Cross Blue Shield of Michigan (BCBSM) or Blue Care Network (BCN). A first-level appeal is a formal written appeal letter or other written documentation from the member requesting reconsideration of an advised benefit deletion. A second-level appeal is regarded as any time a member submits a second letter to BCBSM, BCN or, for Administrative Services Contact groups handling their own appeals the group, appealing the first-level appeal determination.

Note: Pre- and post-service claim appeals must be filed in writing. Urgent care claim appeals may be requested via the telephone.