Appealing a Denied Claim

If a claim for benefits is partially or fully denied, you will receive written notification, which will include the reasons for the denial, a description of any information necessary to complete the processing of your claim and information on how to submit the claim for review.

If you have a question regarding the payment of a claim, you may write or call:

Member Grievance Program
Blue Cross Blue Shield of Massachusetts
One Enterprise Drive
Quincy, MA 02171-2126
Phone:  1-800-472-2689
Fax: 617-246-3616

If you write, be sure to include your identification number and your telephone number. Letters will be answered within 30 days.

You have a right to request a full and fair review of any claim. If you believe you or a covered family member were wrongly denied all or part of your benefits, you may appeal the decision. You may submit questions and comments in writing and review all pertinent plan documents.

Blue Cross Blue Shield of Massachusetts must review your appeal and make a final decision within a reasonable period of time. The final written decision must state specific reasons and plan provisions on which the review decision was based.

Read additional information about appealing a denial of benefits.