If you requested approval for a prescription drug that your HMO or PPO plan doesn't cover and Blue Cross Blue Shield of Michigan or Blue Care Network denied your request, this information tells you how to request an external review.
If we denied your request to approve a prescription drug that your plan doesn’t cover, you or an authorized representative may be eligible for external review by an independent review organization, or IRO. If applicable, we’ll also include an external review form with your denial letter.
You'll need to request a review within four months of the date you received our decision.
Please mail the following:
BCBSM External Review Requests
Blue Cross Blue Shield of Michigan
600 Lafayette East — Mail Code 1620
Detroit, MI 48226-2998
Appeals and Grievance Unit — Pharmacy External Review
Blue Care Network
P.O. Box 284
Southfield, MI 48037-0284
As soon as we get your request, we'll assign your case to an independent review organization. They'll inform you of their decision within 72 hours.
If they determine that we should cover the drug, we'll abide by their decision and cover the drug for the duration of the prescription, including refills.
If we denied your request and your circumstances are urgent, you may be able to request an urgent external review by an independent review organization.
You may qualify for an urgent review if:
Within 10 days of receiving our denial, you or an authorized representative will need to call one of the following numbers:
Immediately after receiving your request, we'll assign your case to an IRO. They'll inform you of their decision within 24 hours of receiving your request.
If you have any other questions, please call the number on the back of your member ID card.
Privacy issues: To report a concern or if you think your protected health information has been compromised, please call us at 1-800-552-8278 or email us. Don't include any protected health information in your email.
Other issues: For customer service, call the number on the back of your member ID card.