The first step is to call Member Services at the number printed on the back of your Medicare Plus BlueSM PPO or Prescription BlueSM PDP ID card.
- We try to resolve all complaints upon first contact from you.
- If you request an answer in writing, we will answer you in writing.
If you do not want to call or you did call and you still do not believe your complaint was resolved, you may submit your complaint and we will use the formal grievance process to respond to you. Or, if you prefer, you may initiate your complaint in writing.
Mail non-prescription drug concerns to:
Blue Cross Blue Shield of Michigan
Grievance and Appeals Department
P.O. Box 2627
Detroit, MI 48231-2627
You may also fax it to us at: 1-877-348-2251
Mail prescription drug concerns to:
Blue Cross Blue Shield of Michigan
Pharmacy Help Desk — C303
P.O. Box 807
Southfield, MI 48037
You may also fax it to us at: 1-866-601-4428
To request a Coverage Determination, Appeal or Grievance online, click here.
Here are some examples of concerns that may qualify as a standard complaint or grievance:
- If you believe confidential information or your privacy has not been respected.
- If someone who provided care to you, or their staff, was rude or disrespectful.
- If you are unhappy with the service you received by our Member Services Department.
- If you waited too long to get an appointment for a service.
- If you waited too long for prescriptions to be filled.
Medicare guidelines require you to initiate the complaint within 60 days of the problem that you are complaining about. In most cases, we will use the standard timelines for responding. This means we will generate a response to you within 30 days of receipt. Sometimes we may extend this timeframe by 14 days, if the delay is in your best interest or you ask us to allow you more time to provide additional information to support your complaint.
We will give you an answer within 24 hours if you ask for a "fast decision." There are only two types of concerns that qualify for a "fast decision." They are:
- If you have asked Blue Cross Blue Shield of Michigan to give you a "fast decision" about a service you have not yet received and we have refused.
- If you do not agree with our request for a 14-day extension to respond to your standard complaint [grievance, coverage decision (organization determination) or pre-service appeal].
Medicare's complaint form can be found here: https://www.medicare.gov/medicarecomplaintform/home.aspx Medicare's Beneficiary Ombudsman office can help you with complaints, grievances and information requests.
The information above is a brief summary. Refer to your Evidence of Coverage for complete information about your rights, benefits and responsibilities (Chapter 8 for Medicare Plus Blue PPO members; Chapter 6 for Prescription Blue PDP members).
For expedited requests ("fast decisions") only, you may call 1-877-241-2583, 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Certain services avilable 24/7 through our automated telephone response system.You may also fax to 1-877-348-2251.
H9572 S5584_W_Jan14BCBSMAdvWeb CMS Approved 01292014
Important information about these plans
Medicare Plus Blue and Prescription Blue are PPO and PDP plans with a Medicare contract. Enrollment in Medicare Plus Blue and Prescription Blue depends on contract renewal.
Medicare Plus Blue PPO
Medicare Plus Blue PPO is available to all Medicare beneficiaries who are Michigan residents and are entitled to receive services under Medicare Part A and enrolled in Part B.
With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare-allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit http://www.bcbsm.com/medicare/find-a-doctor/.
Prescription Blue PDP
Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.
Medicare Plus Blue PPO and Prescription Blue PDP
Premiums vary by county. You must continue to pay your Medicare Part B premium. You may enroll in only one Part D plan at a time.
Limitations, copayments and restrictions may apply.
Our network includes approximately 2,400 Michigan retail pharmacies, representing approximately 98 percent of all Michigan pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.
In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances; for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-241-2583, 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Certain services available 24/7 through our automated telephone response system. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X521, Detroit, MI 48226.
If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and or copayments/coinsurance may change on Jan. 1 of each year.
Medicare beneficiaries may enroll in Medicare Plus Blue PPO or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCBSM does not control Medicare's website and is not responsible for its content. You may only enroll in Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year.
For more information, please contact Blue Cross Blue Shield of Michigan at 1-888-563-3307. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14.
Legacy Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. Legacy Medigap is a Medigap health insurance policy administered by Blue Cross Blue Shield of Michigan. Neither Blue Cross Blue Shield of Michigan nor agents authorized to sell Blue Cross Blue Shield of Michigan policies are connected with Medicare.