Anthem blue cross blue shield grievances and appeals atlanta ga

At Blue Cross and Blue Shield of Illinois (BCSBIL), we take great pride in ensuring that you receive the care you need. But if you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal.

Grievance (Complaint):

A grievance is a complaint about any matter besides a service that has been denied, reduced or ended.

BCBSIL takes member complaints very seriously. We want to know what is wrong so we can make our services better. If you have a complaint about a provider or about the quality of care or services you have received, you should let us know right away. BCBSIL has special procedures in place to help members who file grievances. We will do our best to answer your questions or help to meet your concern. Filing a complaint will not change your health care services or your benefits coverage.

You may want to file a grievance if:

• Your provider or a BCBSIL employee did not respect your rights
• You had trouble getting an appointment with your provider in an reasonable amount of time
• You were unhappy with the care or treatment you received
• Your provider or a BCBSIL employee was rude to you
• Your provider or a BCBSIL employee did not respect your cultural needs or other special needs you may have

Appeals:

An appeal is a way for you to ask for someone to review our actions. You might want to file an appeal if BCBSIL:

• Does not approve a service your provider asks for
• Stops a service that was approved before
• Does not pay for a service your PCP or other provider asked for
• Does not give you the service in a timely manner
• Does not answer your appeal in a timely manner
• Does not approve a service for you because it was not in our network

If BCBSIL decides that a requested service cannot be approved, or if a service is reduced, stopped or ended, you will get a “Notice of Action” letter from us. You must file your appeal within 60 calendar days from the date on the Notice of Action letter. This letter will tell you the following:

• What action was taken and the reason for it
• Your right to file an appeal and how to do it
• Your right to ask for a State Fair Hearing and how to do it
• Your right in some circumstances to ask for an expedited appeal and how to do it
• Your right to ask to have benefits continue during your appeal, how to do it and when you may have to pay for the services

How to File an Appeal or Grievance:

There are two ways to file an appeal or grievance (complaint):

• Call Member Services at 1-877-860-2837. If you do not speak English, we can provide an interpreter at no cost to you. If you are hearing impaired, call the Illinois Relay at 711.
• Write to us at:

Blue Cross Community Health Plans
Attn: Grievance and Appeals Unit
P.O. Box 27838
Albuquerque, NM 87125-9705
Fax: 1-866-643-7069

After you file an appeal, we will call to tell you our decision and send you and your authorized representative a Decision Notice. If you disagree with the decision made on your appeal, you can ask for an External Review within 30 calendar days of the date on the Decision Notice. You may also ask for a State Fair Hearing Appeal within 120 calendar days of the date on the Decision Notice.

For more information regarding Appeals and Grievances, please see your Member Handbook.
 

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What to Do if You Have a Complaint

Your satisfaction with Anthem and your health care plan matters to us. If you have an issue, we’ll work hard to resolve your complaint or grievance in a way that’s stress-free and easy for you.

Call Us for the Fastest Support

Giving us a call is usually your fastest road to resolution. Our experts are here to listen to your issue and offer advice or solutions.

Call us

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You Can Also Mail or Fax a Written Complaint

If you would prefer to send a written complaint you can mail or fax it using the information below. Please include your preferred contact information so that we can reach out to you with additional questions if needed.

Mail It

Appeals and Grievances 

Mailstop: OH0102-B325 

4361 Irwin Simpson Rd 

Mason, OH 45040 

Send A Fax

1-888-456-1406 (Medical) 

1-888-456-1407 (Pharmacy) 

Appeals

If you’d like an update on your issue or information on the aggregate number of grievances, appeals, and exceptions filed, please call the number for your plan and state listed above.

If you feel you have exhausted all your options with us, you can also submit feedback directly to Medicare.

Anthem Blue Cross and Blue Shield is a PDP plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.

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