Appeals and Grievances

Member Appeals and Grievances

If you disagree with Blue Cross Blue Shield of Arizona's (BCBSAZ) decision about a prior authorization request, or with how a claim was processed, you have the right to appeal or grieve those decisions. BCBSAZ may use delegated vendors to administer some benefits for some plans. You can also appeal and grieve delegated vendor decisions.

Information on where and how to file an appeal or grievance is available in several places. Look at the Standard Appeal Packet sent to you at enrollment (see below to view or download). Also check your Explanation of Benefits (EOB) document, monthly health statement, and any precertification denial letter. All of these documents have information telling you where to file your initial appeal or grievance request. The customer service section of your benefit plan booklet also has contact information for the appeals and grievances offices for both BCBSAZ and any delegated vendors serving your plan. Use these resources and the guidelines to understand the steps you must take to dispute a decision. The guidelines also include optional forms you and your provider may use to file an appeal or grievance. If you still have any questions about appeals and grievances after reviewing these materials, please call BCBSAZ customer service for help at the number on the back of your member ID card.

More information and forms:

Standard Appeal Packet 1 - for most BCBSAZ members
Standard Appeal Packet 2 - for all self-funded employer groups, except those that have their own customized appeal packets (including State of Arizona employees and Teamsters)
Appeal/Grievance Request Form
Authorized Representative Designation Form
Provider Certification Form for Expedited Appeal