Appeals

What Is an Appeal?

If we make a coverage or payment decision and you are not satisfied with it, you can "appeal" the decision.  That means that our team will take another look at your request and see if we can make a different decision. If you want to appeal a decision, we must get a request from you within 60 calendar days from the date of our first decision.


How to submit an appeal about your medical care:

You or your appointed representative must send a letter or complete the Appeal Form and mail or fax it to:

BlueCross BlueShield of Tennessee
ATTN: Medicare Advantage Appeals & Grievance Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402
Fax: (423) 535-5270

For questions regarding the appeals process, please call the number for your plan:

BlueAdvantage (PPO) 1-800-831-BLUE (2583)
TTY:711


How to submit an appeal over a prescription drug:

You, your physician or your appointed representative must send a letter or complete the redetermination form and mail or fax it to our plan.

Request for Redetermination of Medicare Prescription Drug Denial Form

Mail:
BlueCross BlueShield of Tennessee Medicare
Part D Coverage Determinations and Appeals
1 Cameron Hill Circle, Suite 51
Chattanooga, TN 37402-0051

Fax:
423-591-9514

Call:
1-800-831-2583

TTY: 711
Hours: Hours: 8 a.m - 9 p.m. EST Monday through Friday
If asked to leave a message, your call will be returned the next business day


More detailed information is available:

For an overview of the entire appeals process, please see Chapter 9 of your Evidence of Coverage located on the Forms and Documents page. Or call the Member Service number above for your plan.

Contact Member Service to obtain a total number of grievances, appeals and exceptions filed with this plan.


How to Appoint a Representative:

You may assign someone like a family member, friend, advocate, attorney or any doctor to act as your representative and file an appeal for you. A representative may:

  • Get information about your claim as allowed by federal and state law
  • Submit evidence
  • Make statements of fact and law
  • Make any request, give or receive any notice about the appeal proceedings

If you want to assign a representative to ask for an appeal for you, both you and your representative must sign, date and fill out the Appointment of Representative Form. The signed form must be filed with your appeal and can be mailed or faxed to:

BlueCross BlueShield of Tennessee
ATTN: Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

Fax:
(423) 535-5270


Do You Need Extra Help?

You may begin an external appeal with an outside agency at the same time we’re reviewing your appeal if you have an urgent health care need or you are getting ongoing care. If you think you need support from an outside agency, you can contact one of the resources below.

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