A grievance is any complaint, other than one that involves a request for an organization determination, a coverage determination or an appeal, as described in Section 9 of your Evidence of Coverage because grievances do not involve problems related to approving or paying for care or Part D benefits, problems about having to leave the hospital too soon and problems about having Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF) services ending too soon.
What types of problems might lead you to file a grievance?
You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. Please call Customer Service for this information.
Filing a Grievance With Our Plan
If you have a complaint, please call Customer Service. We will try to resolve your complaint over the phone. If you ask us for a written response, we will respond in writing to you. If we cannot resolve your complaint over the phone, we have a formal procedure to review your complaints. We call this our Medicare Advantage Grievance and Resolution Process.
To use the formal grievance procedure, send your grievance in writing or request a Customer Advocate assist you in documenting your issue. Send it to:
Blue Cross of Idaho
We will write to you and acknowledge receipt of your grievance within fourteen (14) days. In some instances we will need additional time to address your concern. You will receive a written response from us within thirty (30) days of receipt of your grievance. See your Evidence of Coverage for more information, the chapters are referenced for your convenience.
Y0010_MK 13121 Approved 12-31-2012
Last updated 12-28-2012