Appealing a Denial for Either Dental Health Plan

How to Request a Formal Grievance Review

To request a formal review from Blue Cross Blue Shield’s Grievance Program, you (or your authorized representative) have three options.

The preferred option is for you to send your grievance in writing to:

Member Grievance Program
Blue Cross Blue Shield of Massachusetts
One Enterprise Drive
Quincy, MA 02171-2126

Blue Cross Blue Shield will let you know that your request was received by sending you a written confirma­tion within 15 calendar days.

Or, you may email your griev­ance to Blue Cross Blue Shield’s Grievance Program email address at grievances@bcbsma.com. Blue Cross Blue Shield will let you know that your request was received by sending you a confirmation immedi­ately by email.

Or, you may call Blue Cross Blue Shield’s Grievance Program at 1-800-462-5601 (extension 63605). When your request is made by tele­phone, Blue Cross Blue Shield will send you a written account of the grievance within 48 hours of your phone call.

Once your request is received, Blue Cross Blue Shield will research the case in detail, ask for more informa­tion as needed, and let you know in writing of the decision or the out­come of the review. If your grievance is regarding termination of coverage for concurrent services that were previously approved by Blue Cross Blue Shield, the disputed coverage will continue until this grievance review process is completed. This continuation of coverage does not apply to services that are limited by dollar or visit maximums and that exceed those maximums, non-covered services, or services that were received prior to the time that you requested a formal grievance review, or when a grievance is not received on a timely basis, based on the course of treatment.

All grievances must be received by Blue Cross Blue Shield within one year of the date of treatment, event, or circumstance, such as the date you were told of the service denial or claim denial.