Grievance and Appeals Process for PPO and Traditional Members

What is this about?

If you have a problem with your Blue Cross Blue Shield of Michigan service, this information explains what you can do to resolve it.

Resolve problems

Blue Cross Blue Shield of Michigan wants you to be 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, we encourage you to contact Customer Service. The telephone number can be found on the back of your Blues ID and the top right hand corner of your Explanation of Benefit Payments statements.

Grievance and appeals process

If you are 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 are eligible for an appeal under a state or federal process.

Under either process, you will not incur additional charges 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 Appeal Form (PDF) to submit an appeal. The form is optional and can be used by itself or with a formal letter of appeal.

You may authorize your physician or someone else to act on your behalf at any step of the grievance or appeals process. You'll need to use the Authorized Representative Form (PDF) if you choose to do this. 

State process

If you are enrolled for coverage as an individual subscriber, with an insured group, or through a self-funded non-ERISA group, you are eligible under the state process. You have two years from the date of discovery of a problem to file a grievance with, or appeal a decision of, Blue Cross Blue Shield of Michigan.

Federal process

If you are enrolled for coverage through a self-funded ERISA group, you are eligible for under the federal process. You have 180 days from the receipt of our notice denying or reducing payment on your claim to file an appeal with Blue Cross Blue Shield of Michigan.



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