Urgent External Review
If you have filed a request for an urgent internal review, you may request an urgent external review by an independent review organization.
You may file a request for an urgent external review only when you think that we have wrongfully denied, terminated or reduced coverage for a health care service prior to your having received that health care service.
The expedited external review process is as follows:
Within 10 days of your receipt of our denial, termination or reduction in coverage for a health care service, you or your authorized representative may request an urgent external review by an independent review organization by writing to:
BCBSM External Review Requests
Blue Cross Blue Shield of Michigan
600 Lafayette East — Mail Code 2004
Detroit, MI 48231-2998
You may also call 313-225-0646 to request the review.
Immediately after receiving your request, we will randomly assign it to an independent review organization. The IRO will inform you directly of its decision, within 72 hours of receiving your request for external review.
You should also know
You may authorize another person (including your physician) to act on your behalf at any stage in the expedited internal grievance process. You authorization needs to be in writing.
To qualify for an urgent external review, all of the following requirements must be met:
- An internal urgent has been requested.
- The request for external review is within 10 days of receipt of an adverse determination.
- A physician substantiates the medical condition involved in the adverse determination is serious enough to jeopardize the life or health of the covered person.