Internal Appeals

Federal process

Under the appeals process, we must provide you with our final written determination within 30 calendar days of our receipt of your written appeal, unless you grant us additional time. The timeframe may be suspended for up to 45 days if we have not received information we have requested from a health care provider, such as your doctor or hospital.

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 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 2004
      Detroit, MI 48231-2998
  2. We will respond to your appeal in writing within 30 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 30 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 30 days to give you our final determination, you have the right to allow us additional time if you wish.
  • You may obtain copies of information relating to our denial, reduction or termination of coverage for a health care service free of charge.
  • 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 Office of Financial and Insurance Regulation at 1-877-999-6442 or for general information, you can visit the Department of Licensing and Regulatory Affairs website.


imp-info

Questions?

If you have any questions about our online privacy practices, call 313-225-9000.

©1996-2014 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

Explanation of Level A Conformance
Better Business Bureau Online Seal of Reliability