If you don’t agree with our decision, you have one year to ask for a free external review from the Office of Personnel Management, or OPM. Anyone you’ve authorized to represent you can also request a review.
You can send your request by mail or email to one of the addresses below. Be sure to include a copy of our final determination with your request.
MSPP External Review
National Healthcare Operations
U.S. Office of Personnel Management
1900 E Street, NW
Washington, DC 20415
You’ll also need to submit an intake form. OPM will either give you the form or help you find it online. You choose how much information you want to include on the form. However, if you leave out necessary information, OPM may not conduct your review, or they may decide it adversely.
If you need help with the appeal process, contact the Office of Personnel Management at 1-855-318-0714.
How OPM will use your information
OPM will use your information for general management of the external review system, including:
- Determining if you’re eligible for external review
- Conducting your external review
- Giving you and Blue Cross Blue Shield of Michigan a record of the external review
- Tracking and reporting on the external review system
OPM may disclose your records to:
- Agency contractors, such as Independent Review Organizations, so they can conduct an external review.
- The National Archives and Records Administration, or NARA, or the General Services Administration, or GSA, for records management.
- OPM program and policy staff for statistical and analytical studies, or to plan health program changes.
- Researchers inside and outside of the Federal Government looking at insurance trends and topical issues. OPM approves them in advance based on demonstrated aptitude and a written research plan.
OPM may also use your records for:
- Responses to your congressional inquiries.
- Investigations of potential violations of law, and judicial or administrative proceedings to which the Federal Government is a party. In this case, OPM may provide your information to another agency, a court, an administrative body or to the Department of Justice, when it’s relevant to the proceeding.
- Investigations of data breaches and responses to data breaches.
How OPM will use your social security number
OPM may need your social security number, or SSN, to identify your unique records as authorized by Executive Order 9397. You’re not required to disclose your SSN. However, if you don’t provide it when requested, you may prevent or delay your review.
Documents submitted to OPM as part of your appeal may include your SSN. OPM will send a copy of any information you send to them to Blue Cross Blue Shield of Michigan.
Your right to request documentation
You have the right to ask for any documents related to the appeal decision free of charge. This could include things like:
- Benefit provisions
- Medical policies
- Diagnosis and treatment codes, and what they mean, unless precluded by other laws
- The standard on which the adverse determination was based, if applicable
To request copies of these documents, please write to:
600 E. Lafayette Blvd
Mail Code 2004
Detroit, Michigan 48226-2998
OPM has the authority to administer the Multi-State Plan Program under section 1334 of the Affordable Care Act (42 U.S.C. 18054).