Grievance and Appeals Process for PPO, EPO and Traditional Members

What is this about?

If you have a problem with your Blue Cross Blue Shield of Michigan service, this information explains what you can do to resolve it.

Resolve problems

Blue Cross Blue Shield of Michigan wants to make sure you're satisfied with the services you receive as a member. If you have a question or concern about how we processed your claim or request for benefits, contact customer service. You can find the number on the back of your Blues ID card. It's also at the top right-hand corner of your Explanation of Benefit Payments statements.

Grievance and appeals process

If you were unable to resolve your concern through customer service, we have a formal grievance and appeals process. The length of time you have to file an appeal will depend on whether you're eligible for an appeal under a state or federal process.

Under either process, we won't charge you anything extra for filing a grievance or appeal. You may submit written materials or testimony to help us in our review at any step of the grievance or appeals process. You can use the Member Appeal Form (PDF) to submit your appeal. The form is optional. You can use it by itself or with a formal letter of appeal.

You can select someone to act on your behalf at any step of the grievance and appeals process, including your physician. Just fill out the Authorized Representative Form (PDF). This form gives your representative the permission to communicate with Blue Cross Blue Shield of Michigan on a one-time basis about your appeal.

If you're a provider and you need to submit an appeal, use the Provider Appeal Form (PDF).

State process

If you have individual, group or self-funded non-ERISA group coverage, you're eligible under the state process. You have 180 days from the date of discovery of a problem to file a grievance with, or appeal a decision of, Blue Cross Blue Shield of Michigan.

Federal process

If you have coverage through a self-funded ERISA group, you're eligible under the federal process. You have 180 days from the day we notified you of denial or reduction in payment on your claim to file an appeal with Blue Cross Blue Shield of Michigan.



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