Medical Grievances, Appeals and Advance Determination
What is a Grievance?
If you have a problem with any of our medical policies and procedures, you may file a grievance. You cannot be dropped from the plan for making a complaint.
How to File a Grievance
You may call Customer Service to verbally file a grievance or to check on the status of a grievance:
1-800-841-7434
TTY/TDD for Hearing Impaired: 1-88-423-9490
8 a.m. to 9 p.m. ET, 7 days a week
From March 3 to September 30, you may be required to leave a voice mail on weekends and holidays. Calls will be returned within one business day.
Complete the Grievance Form  . Supporting statements from your physician are required. Mail or fax to:
BlueCross BlueShield of Tennessee
Attn: BlueAdvantage Operations
Appeals/Grievance Coordinator
P.O. Box 180205
Chattanooga, TN 37402
Fax: (423) 535-8846
What is an Appeal?
If we deny a claim or service, we will explain why. If you disagree with our decision regarding the handling of your claim or a denial of a service, you have the right to file an appeal. Your claim will be reviewed again. If you are still not satisfied with the decision, your appeal will be reviewed by an independent organization that works for Medicare.
How to File an Appeal
You may call Customer Service to verbally file an appeal or to check on the status of an appeal:
1-800-841-7434
TTY/TDD for Hearing Impaired: 1-88-423-9490
8 a.m. to 9 p.m. ET, 7 days a week
From March 3 to September 30, you may be required to leave a voice mail on weekends and holidays. Calls will be returned within one business day.
Complete the Appeal Form . Supporting statements from your physician are required. Mail or fax to:
BlueCross BlueShield of Tennessee
Attn: BlueAdvantage Operations
Appeals/Grievance Coordinator
P.O. Box 180205
Chattanooga, TN 37402
Fax: (423) 535-8846
Appointing a Representative to Act on Your Behalf
You may assign someone such as a relative, friend, advocate, an attorney or any physician to act as your representative and file an appeal for you. A representative may:
- Obtain information about your claim to the extent consistent
with current Federal and state law;
- Submit evidence;
- Make statements of fact and law; and
- Make any request, or give or receive any notice about the appeal
proceedings.
Both you and your representative must sign, date and complete the Appointment of Representative Form . If you want to assign a representative to ask for an appeal for you, this signed form must be filed with your appeal. Unless you decide you no longer want to have a representative, the form will be good for one year after the date you and your representative sign the form. If future appeals are filed during this time, your representative must file a photocopy of the signed representative form for each appeal. If your physician agrees to act as your representative and files an appeal for you, you cannot be charged by your physician for filing the appeal.
BlueAdvantage members only need to complete the first three sections of this form. Mail or fax the form to:
BlueCross BlueShield of Tennessee
Attn: BlueAdvantage Operations
Appeals/Grievance Coordinator
P.O. Box 180205
Chattanooga, TN 37402
Fax: (423) 535-8846
More Detailed Information is Available
This information is a brief overview of the BlueAdvantage medical grievance and appeals process. Please see your Evidence of Coverage for more information.
How to Request an Advance Determination
Advance determinations are usually requested directly by your physician. However if you need to submit a request yourself, have your doctor complete the appropriate form and mail or fax it to:
BlueCross BlueShield of Tennessee
Attn: BlueAdvantage Operations
Appeals/Grievance Coordinator
P.O. Box 180205
Chattanooga, TN 37402
Fax: 1-888-535-5243
For medical advance determinations, please use the appropriate form below:
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