How can I resolve a problem with my HMO coverage?
Who is this for?
If you’re a Blue Care Network member and have a problem with a claim, this explains how to report it, and the grievance and appeals process.
It’s important to us that you’re satisfied with the service you receive or the way a claim or request for benefits is handled. If you have a problem, we want to help.
Who should I contact?
Is it about care you received from a doctor, hospital or healthcare facility?
Start by talking to your primary care physician. If you’re not sure who that is, or need their contact info:
- Log in to Member Secured Services. If you’ve haven’t visited Member Secured Services before, you’ll need to register first.
- Go to Manage my Plan,” then “Primary care physician – view or change.
If it’s about service you received from Blue Care Network, or a problem with a claim, please contact us.
I talked to my primary care physician or Customer Service, and I still have a problem. Now what?
We have a formal grievance and appeals process you can follow. You can begin this process up to two years from when the problem started. It doesn’t cost you anything to file a grievance or appeal a decision.