Appeals and grievances

If you are unsatisfied with something related to your Blue Medicare HMO or Blue Medicare PPO coverage, please let us know. We will try to resolve any complaint that you might have over the phone. If we cannot resolve your complaint over the phone, we will give you details on filing a formal grievance. Your complaint will be reviewed through the Grievance Procedure.

To obtain an aggregate number of Medicare Advantage Plan grievances and exceptions, you may call Customer Service at 1-888-310-4110 (toll-free), 1-888-451-9957 (TDD/TTY), 7 days a week, 8am to 8pm.

Standard appeals
You can also appeal a coverage decision. To file a standard appeal, you or your authorized representative should send a written request to:

Blue Medicare HMO or PPO
Appeals and Grievances Department
P.O. Box 17509
Winston-Salem, NC 27116-7509

Fast appeals
If you or your doctor believe that waiting on a standard decision could seriously harm your health or your ability to function, you, your authorized representative or your doctor can ask for a fast appeal.

To file a fast appeal call Customer Service:
1-888-310-4110
1-888-451-9957 (TDD/TTY)
7 days a week, 8 a.m. - 8 p.m.
If calling after business hours, just follow the prompts to file a fast appeal.

Appealing a Notice of Medicare Non-Coverage
If you receive an advance Notice of Medicare Non-Coverage for skilled nursing, home health or comprehensive outpatient rehabilitation services from the provider of the service, you are entitled to file an appeal with the Quality Improvement Organization (QIO), rather than Blue Medicare HMO or PPO, regarding the upcoming termination of services. Please follow the instructions contained in the Notice for the steps to follow to file an appeal with the QIO.

Please see your Evidence of Coverage for a detailed explanation of the appeals and grievance procedures and timeframes for a response.