How can I resolve a problem with my Blue Cross Blue Shield of Michigan claim?

It’s important to us that you’re satisfied with the way a claim or request for benefits is handled.

If you have a problem, please call us first.

Use the phone number on the back of your enrollee ID card, or in the top right hand corner of your Explanation of Benefit (EOB) statement. We’ll do our best to help.

I talked to Customer Service, and I still have a problem. Now what?

We have a formal grievance and appeals process you can follow. It doesn’t cost you anything to file a grievance or appeal a decision.

Use the state process if you:

• Are insured through your employer (including non-ERISA groups)
• Buy your own insurance

You can begin this process up to two years from when the problem started.

If you’re insured through a self-funded ERISA group, you’ll use the federal process. You can begin this process up to 180 days after you get a notice from us that denies or reduces payment on a claim.

There are occasions when we can speed up the grievance and appeals process. For example, if waiting would jeopardize your life or health. Choose the same process you’d use to file a standard grievance or appeal.

State process (expedited internal grievance)

Federal process (urgent internal review)

Related Items

• How can I resolve a problem with my HMO coverage?
• Claims FAQ
• Claims forms