If you have a medically necessary need for a non-formulary drug, you can ask us to make an exception and cover the drug. We respond to exception and appeal requests within 72 hours. There are three types of exceptions that you can ask for.
If we deny your exception request, we will mail you a letter explaining why your request was denied. This letter will include how you can appeal our decision. You can ask for a standard or expedited appeal.
If your prescribing doctor supports your expedited appeal or requests an expedited appeal for you, we automatically grant you a faster decision. If you request an expedited appeal without support from a doctor, we determine whether or not your health situation requires a fast appeal. In the event we determine your situation does not require a fast decision, we give you a decision within 7 days. We will not expedite an appeal for a drug you already receive.
How to request an appeal
Your appeal should include
We will review your appeal and give you a decision. If we deny an appeal, you can request an outside review by an independent reviewer not associated with our plan.
If you disagree with that decision, you still have the right to further appeal. We will notify you of your appeal rights if this happens.
Our contact information
If you need help with an appeal, call Customer Service at 1-888-494-2583 or TTY 1-800-377-1363, 8 a.m. to 8 p.m., seven days a week.
Medicare beneficiaries may enroll in Blue Cross of Idaho Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Call from 8 am to 8 pm
7 days a week
3000 E Pine Ave.
Meridian, ID 83642-5996
P.O. Box 8406
Boise ID 83707-2406
If you have special needs, the information on this site may be available in other formats or languages. To find out more call 1-888-494-2583.
Blue Cross of Idaho is a PPO, HMO or HMO POS health plan with a Medicare contract. Enrollment in Blue Cross of Idaho depends on contract renewal.