Member Appeals

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BCBSGa Member Grievances and Appeals

1. What is the procedure for lodging a grievance against a provider or against the Plan?
Fax the details of your grievance to 1.877.868.7950 or call the customer care number on your member ID card. Your inquiry should be resolved within 21 calendar days.  
2. How do I express dissatisfaction regarding a denial of services?
As a member, you have a right to express dissatisfaction and to expect fair resolution of your issues. BCBSGa established the inquiry, formal complaint, and appeal process to be used any time you are displeased with any aspect of services rendered: 

Inquiry: You may call customer care at the phone number listed on your member ID card. Describe your concern and we will make every effort to respond within 21 calendar days.

Formal complaint: If you are not satisfied with our response, you may file a formal complaint, preferably, in writing. Fax the details of your request, along with supporting documentation, to 1.877.868.7950 or you may call customer care number on your member ID card.

Appeal: If you choose to appeal, your written request with comments, documents, records, or other relevant information should be faxed to 1.877.868.7950. The request may also be mailed to BCBSGa, PO Box 9907, Columbus GA 31908.

At the conclusion of this appeal review, a written response addressing your specific concerns will be provided within 30 calendar days of receiving your request.

 
 
Independent Medical Review
In the event of a benefit denial, you may be eligible to request an independent review.  
If you meet the eligibility requirements, the Georgia Department of Community Health will coordinate an independent review on your behalf with an Independent Review Organization (IRO). The IRO will ensure that you have access to an objective third party review, which is not influenced by or affiliated with the health plan. Your right to an independent review is limited by specific eligibility guidelines: 

You must have exhausted all levels of internal appeals

The cost of the services in question must exceed $500

Benefit denial must relate to a denial of coverage based on medical necessity or an experimental/investigational procedure

 
Blue Cross Blue Shield Healthcare Plan of Georgia will notify you if you are eligible for an independent review. If you have any questions about your right to an independent review, please contact the Customer Care phone number listed on your member ID card. 

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