Requesting an expedited grievance
From Blue Care Network
You may request an expedited grievance when:
- A physician provides verbal or written confirmation that you have a medical condition for which the time frame for completing a standard grievance would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function.
- You believe that we have wrongfully denied, terminated or reduced coverage for a health care service prior to your having received that health care service, or you believe we have failed to respond timely to a request for benefits or payment.
Submit your request for an expedited grievance to us in writing by mail or by fax. Your physician must also confirm that your condition qualifies for an expedited grievance. Your physician's confirmation can be submitted in writing — by mail or by fax — or by telephone.
Mail or fax your request to:
Appeals and Grievance Unit — Mail Code C248
Blue Care Network
P.O. Box 284
Southfield, Michigan 48086
Telephone: 800-662-6667
Fax: 888-458-0716
We must provide our decision within 72 hours of receiving both your grievance and your physician's substantiation. If our decision is communicated to you verbally, we must provide a written confirmation within two business days.
If you do not agree with our decision, you may request an expedited external review from the Office of Financial and Insurance Regulation within ten calendar days of receiving our decision.
From the State
You may request an expedited external review from the State of Michigan when all three of the following conditions are satisfied:
- A physician provides verbal or written confirmation that you have a medical condition for which the time frame for completing a standard external review would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function.
- You have filed a request with Blue Care Network for an expedited internal grievance. You do not have to wait for our final determination before you request an expedited external review.
- You believe that we have wrongfully denied, terminated or reduced coverage for a health care service prior to your having received that health care service.
To request an expedited external review from the state, submit your request to the insurance commissioner at the same time you file your request for an expedited internal review with BCN or within ten calendar days of receiving our final determination. Your request can be made over the phone or in writing.
Office of Financial and Insurance Regulation
Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720
Toll-free telephone: 877-999-6442
*Employee Retirement Income Securities
page modified 05/12/2008