Coverage Decisions

What Is a Coverage Decision?

A coverage decision is a decision your plan makes about what it will cover or about the amount to be paid for your medical services or drugs. A medical coverage decision is also called an “organization determination."


How to request coverage for a medical service:

You, your doctor or your representative can call, write or fax our plan to make your request for us to provide coverage for the medical care you want.

Call Member Service at 1-800-831-BLUE (2583) (TTY: 711).

Mail:
BlueCross BlueShield of Tennessee
BlueAdvantage Operations
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

Fax:
(423) 535-5498


How to request coverage for a prescription drug:

You, your physician or your appointed representative can call or complete the coverage determination form and mail or fax it to our plan to make your request for us to cover a prescription drug.

BlueAdvantage Request for Medicare Prescription Drug Coverage Determination

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

Fax:
Fax Number: 423-591-9514

Call:
1-800-831-2583
TTY: 711
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 coverage decision 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 a coverage decision 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 coverage decision request 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

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