What is the two-step appeals process for ERISA and non-ERISA underwritten groups?
Blue Cross Blue Shield of Michigan (BCBSM) has adopted a two-step appeals process that includes handling both levels of appeals for members.
State law (Michigan Public Act 250) also applies to insured ERISA plans unless it prevents the application of the DOL regulations. For example, PA250 requires BCBSM and Blue Care Network (BCN) to decide appeals of post-service claims within 35 days. Since this rule provides members quicker review times than the DOL regulations and does not prevent compliance with the maximum period of 60 days allowed under the DOL rules for finalizing post-service appeals it will be followed. Therefore, members in insured groups will receive notice of determination on appeal of post-service claims within 35 days.