Complaints and Appeals

If you have a complaint regarding a provider, please contact Customer Service at 1-877-258-3334. The complaint will then be researched and handled appropriately.

You have the right to request a formal appeal of a denial of benefit coverage. A detailed description of this process may be found in your Member Guide. Customer Service can also assist you in starting the appeal process.

Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.

You have the right to request a formal appeal of the claim payment or denial. A detailed description of this process may be found in your Member Guide. Customer Service can also assist you in starting the appeal process.

Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.

You have the right to request a more rapid or expedited review of a denial of coverage if a delay would reasonably appear to seriously jeopardize you or your dependent's life, health or ability to regain maximum function. An expedited review may be requested by calling Customer Service at 1-877-258-3334. Blue Cross NC will communicate the decision by phone to you and your provider as soon as possible, but no later than 72 hours after receiving the request for the expedited appeal. A written decision will be communicated within four days after receiving the request for the expedited appeal.

Please notify Blue Cross NC as soon as possible by contacting Customer Service at 1-877-258-3334.