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Grievance and Appeals Forms

Who is this for?

Use these forms to file grievances or appeals

If you want to file a grievance or complaint, or appeal a decision about something in your Medicare plan, we've made these forms for you to use. 

We respect your rights as a Medicare customer. If you have a concern about our services or any of our providers, you can file a complaint.

Call us first. You can start by calling the number on the back of your Blues ID card. If you don't want to call, there are other ways to tell us about your concern. You can send us a form or let us know in writing. How you contact us depends on the plan you have, and if your issue is either medical- or drug-related.

Do you have a Medicare Plus BlueSM PPO plan?

Do you have a BCN AdvantageSM HMO-POS or HMO plan?

Do you have a Prescription BlueSM PDP plan?

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Page Last Updated Fri Sep 19 12:49:34 EDT 2014