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How can I file a complaint, grievance or appeal?

Who is this for?

How can I file a complaint, grievance or appeal?

If you have a concern about your medical care or pharmacy coverage, this information can help you get started.

We want you to be satisfied with the health care you receive. But what happens if you’re not?

Please call us first. Just dial the number on the back of your Blues ID card and we'll do the best to resolve your issue.

What are complaints, grievances and appeals?

If you’re unhappy with a decision we’ve made or with the care you've received, you can make a complaint. There are two types of complaints: grievances and appeals. Sometimes a complaint can be both.

You should file a grievance if you have a complaint about the quality of care you received from a doctor, pharmacist or other service provider.

You should file an appeal if you want us to change a decision we’ve made about:

  • The medical services or prescription drugs your plan covers.
  • What we’ll pay for the services you receive or drugs you take.

Tip:  If you don’t see your medication on our drug list and want to know if we’ll pay for it, you can fill out a coverage determination form.

Ready to file your complaint, grievance or appeal?

Call the number on the back of your Blues ID card or find the online forms you need to get started here.

You can also file a complaint directly with Medicare. Just start here on the medicare.gov website.

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Page Last Updated Wed Nov 19 14:15:51 EST 2014