Appeals and Grievances

Appeals are a procedure that deals with the review of coverage decisions for services or drugs that you believe are entitled to receive, including a delay in providing, arranging for, or approving healthcare services or drugs or, on any amounts you must pay for services or drugs. These appeal procedures include a plan reconsideration or redetermination, a second level review of the plan's decision by a Medicare-contracted independent reviewer, a hearing with an Administrative Law Judge (ALJ) or attorney adjudicator, review by the Medicare Appeals Council (MAC), and judicial review. Instructions on how to appeal are included when you receive a letter denying coverage and in your Evidence of Coverage (EOC). Instructions on how to appeal are included when you receive a denial on a coverage determination decision letter.


Grievances are an expression of dissatisfaction with any aspect of operations, activities, or behavior of Blue Cross Blue Shield of Arizona (AZ Blue) or its delegated entity in the provision of healthcare items, services, or prescription drugs— regardless of whether remedial action is requested or can be taken. A grievance does not include, and is distinct from, a dispute of the appeal of an organization determination or coverage determination, or a late enrollment determination (LEP). A Member can file a grievance by phone or in writing using the contact information below.


If you have concerns about the quality of care or other services you received from any of our providers, you may file a complaint at Medicare.gov

You may also file a written grievance or appeal by downloading an Appeal and Grievance form (English) and mailing or faxing to:

  • Business_Finance_Contact_Phone Number icon

    For Medicare Advantage (MAPD)

    Blue Cross Blue Shield of Arizona
    PO Box 29234
    Phoenix, AZ 85036
    Call 480-937-0409 (In Arizona) or 1-800-446-8331 TTY: 711
    8:00 a.m. to 8:00 p.m., Monday – Friday from April 1 to September 30; and 7 days a week from October 1 to March 31.
    Fax: 602-544-5656
  • Business_Finance_Contact_Phone Number icon

    For Blue MedicareRx (PDP)

    For Grievances
    Blue MedicareRx
    ATTN: Grievance Department
    6860 W 115th Street
    Mail Stop: KS015-1000
    Overland Park, KS 66211

    For Appeals
    PA Appeals c/o Appeals Coordinator
    P.O. Box 2975
    Mission, KS 66201
    Call: 1-888-403-3398
    Fax: 1-877-239-4565
     
    Call Medicare to disenroll: 1-800-633-4227 (TTY: 1-877-486-2048)

Further information and assistance

If you have questions or concerns or want to check the status of coverage determinations, appeals, or would like to file a grievance; have questions about making an AOR; or need help in completing the AOR form; please call Member Services.

Acceptable forms of authorization documentation:

  • Power of attorney (POA) documentation
  • Document showing an individual authorized by a court or authorized under State or other applicable law. An authorized individual can include, but is not limited to, a court-appointed guardian, an individual with durable power of attorney, a healthcare proxy, a person designated under a healthcare consent statute, or an executor of an estate. Legal authorization documentation is valid until its expiration date noted in the document, unless revoked.
  • Completed Appointment of Representative (AOR) form (English, Español). A completed AOR form is valid for one year from the date it has signatures for you and your appointee, unless revoked.
  • Equivalent written notice which includes:
    • Your name, address, and telephone number
    • Appointed individual’s name, address, and telephone number
    • Your Medicare beneficiary identifier (MBI) or plan ID number
    • Appointed individual’s professional status or relationship to you
    • Written explanation of the purpose and scope of the representation
    • Statement that you authorize the appointed individual to act on your behalf
    • Statement authorizing disclosure of individually identifying information to the appointed individual
    • Statement by the individual being appointed that they accept the appointment
    • Signature and signature date by you and the individual being appointed. An equivalent notice is valid for one year from the date it has signatures for both you and your appointee, unless revoked
    Blue Cross® Blue Shield® of Arizona (AZ Blue) is contracted with Medicare to offer HMO and PPO Medicare Advantage plans and PDP plans. Enrollment in AZ Blue plans depends on contract renewal.

    AZ Blue offers BluePathway HMO and BlueJourney PPO Medicare Advantage plans. AZ Blue Advantage, a separate but wholly owned subsidiary of AZ Blue, offers Blue Medicare Advantage Standard, Classic, and Plus HMO plans.

    You are eligible to enroll in a AZ Blue Medicare Supplement plan if you are age 65 or older, entitled to Medicare Part A, and enrolled in Medicare Part B, and you live in the plan service area. You must continue to pay your Medicare Part B premiums (and Part A, if applicable), if not otherwise paid for by Medicaid or another third party. During the first six months when you are age 65 and also enrolled in Medicare Parts A & B you cannot be denied a Medicare Supplement plan when you apply for one, regardless of health status.

    Health Choice Pathway HMO D-SNP is a Health Plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Health Choice Pathway HMO D-SNP depends on contract renewal. Health Choice Pathway Member Services can be reached at 1-800-656-8991, TTY: 711, 8 a.m. to 8 p.m., 7 days a week.

    Blue Cross Blue Shield of Arizona (AZ Blue) and Health Choice Arizona (HCA) comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and written information in other formats such as large print and accessible electronic formats. We also provide free language services to people whose primary language is not English, such as qualified interpreters and written information in other languages. If you need these services call 1-800-446-8331 (TTY: 711) for AZ Blue Medicare Advantage or 1-833-229-3593 (TTY: 711) for AZ Blue Blue MedicareRx (PDP) or 1-800-656-8991 (TTY: 711) for HCA.

    Member Services can be reached at 480-937-0409 (in Arizona) or at our toll-free phone number at 1-800-446-8331 (TTY users should call 711). Hours are 8 a.m. to 8 p.m., Monday through Friday from April 1 to September 30; and 7 days a week from October 1 to March 31. Member Services also has free language interpreter services available for non-English speakers.

    OptumRx® is an independent company providing prescription mail order services.

    Spanish (AZ Blue): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-446-8331 (TTY: 711).

    Navajo (AZ Blue): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-446-8331 (TTY: 711).

    Spanish (HCA): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-656-8991 (TTY: 711).

    Navajo (HCA): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-656-8991 (TTY: 711).

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    Last Updated 01/01/2024