Are there any special requirements for health plans in cases involving medical judgment?

In cases involving medical judgment, the health plan must consult with a health care professional who has appropriate training and experience in the field of medicine involved in the judgment. Upon request, the member who filed the claim is entitled to obtain the identity of the medical experts whose advice was given in connection with the adverse benefit determination.

©1996-2016 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

BCBSM is an Accredited Business through the Better Business Bureau