Don't agree with one of our decisions?  Or have a complaint about: 

• Our service,
• Health plan rules,
• Waiting times to get appointments,
• After-hours access to your doctor, or
• The service at a doctor's office or a doctor's care
• Negative interactions with our business partners/vendors (i.e. Magellan, Express Scripts, etc.)

Note:  There's a separate process for Mental Health or Substance Abuse

 

File a complaint to customer service.

• Call customer service at the number on the back of your member ID.
• In some cases your complaint may result in an first level appeal; customer service representative will notify if it does.

Filing an appeal (also referred to as "grievance")

 Consider contacting customer service before filling an appeal; they can resolve most problems and save you time.

 

If you decide to file, refer to the table below for necessary steps. 

 

Remember:  be very specific with the details of your grievance.
 

Grievances Related to...	Should Be Filed By...
Emergency or Urgent Service	Calling customer service  number on the back of your member ID card
A decision to: deny coverage for services deny eligibility reduce benefits	Calling customer service number on the back of your member ID card -OR- Writing to::       BCBSVT       Grievances       P.O. Box 186       Montpelier, VT 05601-0186
All others	Writing to:       BCBSVT       Grievances       P.O. Box 186       Montpelier, VT 05601-0186

 

 

Reviewal process and appeal decision

• An impartial reviewer will research and resolve your grievance.
• The type of grievance filed will determine the duration.

The table below illustrates the general timeframe in which you can expect to hear BCBSVT's decision on your appeal:

 

if Your review is related to...	You'll be notified of our decision within...
Emergency or Urgent Service	72 hours of request for review
Medical care not yet rendered	30 calendar days of request for review
Medical care already received	60 calendar days of request for review
Non-medical care	30 calendar days of request for review
Other	60 calendar days of request for review

 

Unsatisfied with the outcome of first appeal?

You may file as second level appeal, voluntary/independent appeal,  at no cost.  To do so, write to:

BCBSVT

2nd Level of Appeals

P.O. Box 186

Montpelier, VT 05601-0186

Still not satisfied?

You may request to an external appeal with the State of Vermont by calling:

• (800) 631-7788, or
• (802) 828-2900

More info

Learn more about the appeals process.  

_{Reference: "When You Have A Complaint" section of your Certificate of Coverage.}

 

Updated: 09/06/12