You can file a grievance if you have a complaint about:
- The quality of care you receive.
- The timeliness of service.
- Any other concern (except for the coverage or payment issues listed above).
If you have an issue related to what is covered for medical services, or if you or your appointed representative wish to file a grievance, please visit our Contact Us page.
Important: You must file a grievance with us no later than 60 days after the event or incident in question.
You may also contact Customer Service if you want to know about the number of appeals, grievances or exceptions filed with the plan.
Here are examples of reasons you may file a grievance:
- You feel that you’re being encouraged to leave (disenroll from) our plan.
- Concerns with customer service.
- Long wait times for a pharmacy or medical office.
- Disrespectful or rude behavior by pharmacists or medical staff.
- Cleanliness or condition of pharmacy or medical office.
- You do not agree with our decision not to expedite your request for an expedited coverage determination or redetermination.
- You believe our notices and other written materials are hard to understand.
- The plan sponsor (BCBSIL) failed to give you a decision within the required time frame.
- BCBSIL did not forward your appeal case for an independent review if we didn’t give you a decision within the required time frame.
- We did not provide required notices, and/or the notices did not comply with Centers for Medicare & Medicaid Services (CMS) standards.
Resolving Your Concerns
A grievance must be filed with us no later than 60 days after the event or incident in question.
Resolve by Phone
We try to resolve any complaint you have over the phone. If Customer Service cannot resolve your concern over the phone, we have a formal process to review your complaints. We have made this process easy to follow so you will get a timely response.
- If your concern is not resolved at the time of your first phone call, it will be forwarded to a grievance coordinator to be resolved.
- If your grievance involves the quality of the care you received, you will get a written response.
- You will be sent a written response as quickly as your case requires based on your health status. This will be no later than 30 calendar days after we receive your complaint.
- We may add to the time frame by up to 14 calendar days if you request an extension.
- If there’s a need for more information and the delay is in your best interest, the reply can take longer. When we extend the deadline, we will let you know right away the reason(s) for the delay in writing.
By Mail
You may file a grievance in writing by sending a letter by mail or by fax telling us about your grievance.