Internal Grievance

State process

Under the standard internal grievance process, which includes a managerial-level conference, we must provide you with our final written determination within 35 calendar days of our receipt of your written grievance, unless you grant us additional time. The timeframe may be suspended for any amount of time that you are permitted to take to file your grievance, and for a period of up to 10 days if we have not received information we have requested from a health care provider, such as your doctor or hospital.

The standard internal grievance 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.
   
   • Mail your written grievance to:
     Appeals Unit
     Blue Cross Blue Shield of Michigan
     P.O. Box 2459
     Detroit, MI 48231-2459
   • Once we receive your request for an appeal, we will contact you to conduct or schedule the conference. That will be your opportunity to provide us with any additional information or testimony you want us to consider in reviewing your claim. You can ask that the conference be conducted in person or over the telephone. If in person, the conference can be held at our headquarters in Detroit, during regular business hours. Our written resolution will be our final determination regarding your grievance.
     
2. If you disagree with our final determination, or if we fail to provide it to you within 35 days of the date we received your original written grievance, you may request an external review from the Michigan Commissioner of Financial and Insurance Regulation.

You should also know

• You may authorize another person to act on your behalf at any stage in the standard internal grievance procedure. Your authorization needs to be in writing. You may authorize your physician or someone else to act on your behalf.
• Although we have 35 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.