What is a Grievance or Complaint?
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 and Section 10 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 to Your Filing a Grievance?
- Problems with the service you receive from Customer Service.
- Problems with how long you have to wait at in a network pharmacy.
- Waiting too long for prescriptions to be filled.
- You believe our notices and other written materials are hard to understand.
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
P.O. Box 8406
Boise ID 83707
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. You have the right to an informal hearing if you do not agree with our resolution. See Section 8 of your Evidence of Coverage for more information.
1-888-492-2583 or TTY 1-800-377-1363, 8 am to 8 pm, seven days a week
3000 E Pine Ave. Meridian ID 83642-5996 or P.O. Box 8406, Boise ID 83707-2406
Blue Cross of Idaho is a health plan with a Medicare contract.
Y0010_MK 12155 CMS Approval 11/9/2011