Who is this for?
If you have a problem with your Blue Cross Blue Shield of Michigan service, you can use this form to file an appeal with us.
If you're a Blue Cross Blue Shield of Michigan member and are unable to resolve your concern through Customer Service, we have a formal grievance and appeals process. You can use this form to start that process. The form is optional and can be used by itself or with a formal letter of appeal.
If you have any questions, call the phone number on the back of your Blues ID card and we'll help.
What you'll need:
- Your Blues ID card
- A printer to print the form
- Original receipts from your doctor
- A copier or scanner to make a copy of each receipt for yourself
- An envelope and postage to mail the form