To submit a grievance as a group customer, you or someone authorized by you in writing must submit a written statement of the problem to our Appeals and Grievance unit at the following address:
Appeals and Grievance Unit
Blue Care Network
P.O. Box 284
Southfield, MI 48086
The Appeals and Grievance unit will review your grievance and give you a decision within 15 calendar days for preservice claims (claims that must be decided before a member is afforded access to health care) and within 20 calendar days for postservice claims (claims for a benefit involving the payment or reimbursement of the cost for medical care that has already been provided).
The person or persons who review this first-level appeal are not the same individuals who were involved in the initial determination. If an adverse determination is made, BCN will provide you with a written statement in plain English containing the reasons for the adverse determination, the next step of the grievance process and the forms to request the next grievance step. Upon request, we will provide, free of charge, all documents and records used to reach our determination.
If you are not satisfied with the determination, you may appeal to BCN's Member Grievance Panel within 180 calendar days of receiving our determination. You, or a person authorized in writing to act for you, must notify the Appeals and Grievance unit in writing at the address listed above of your decision to appeal. If you do not file a grievance with BCN's Member Grievance Panel within the 180-calendar day time frame, your grievance is considered abandoned and no further action may be taken.