Internal Appeals

Federal process

Under the appeals process, we must provide you with our final written determination within 60 calendar days of our receipt of your written appeal, unless you grant us additional time. 

The internal appeals process is as follows:

  1. You or your authorized representative must send us a written statement explaining why you disagree with our determination on your request for benefits or payment. You can also use the Member Appeal Form (PDF) if you'd like. The form is optional and can be used by itself or with a formal letter of appeal.
    • Mail your written grievance to:
      DOL/ERISA Appeals
      Blue Cross Blue Shield of Michigan
      600 Lafayette East — Mail Code CS3A
      Detroit, MI 48231-2998
  2. We will respond to your appeal in writing within 60 days. If you agree with our response, the appeal ends.
  3. If you disagree with our final determination, or if we fail to provide it to you within 60 days of the date we received your original written appeal, you may be eligible for an external review by an independent review organization.

You should also know

  • You may authorize another person (including your physician), to act on your behalf at any stage in the internal appeals process. You'll need to complete the Authorized Representative Form (PDF) if you choose to do this.
  • Although we have 60 days to give you our final determination, you have the right to allow us additional time if you wish.
  • You can request free copies of the actual benefit provisions, guidelines, protocols or medical policies that the appeal decision was based on. You can also request diagnosis and treatment codes and what they mean unless prohibited by law.
  • Although not required, you may also include notarized statements, declarations and testimony to support your appeal.
  • If you need assistance with the appeals process, you may contact a Blue Cross and Blue Shield of Michigan representative by calling the number on the back of your Blues ID card.
  • There are also state and federal agencies available to assist you with any additional questions or assistance with the appeals process.
  • At the federal level, you can contact the Federal Employee Benefits Security Administration at 1-866-444-EBSA (3272).
  • At the state level, you can contact the Department of Insurance and Financial Services at 1-877-999-6442 or for general information, you can visit the Department of Insurance and Financial Services website.



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