Appeals and Grievances

Member Appeals and Grievances

If you disagree with Blue Cross Blue Shield of Arizona's (BCBSAZ) decision about a prior authorization request, or with how a claim was processed, you have the right to appeal or grieve those decisions. BCBSAZ may use delegated vendors to administer some benefits for some plans. You can also appeal and grieve delegated vendor decisions.

Information on where and how to file an appeal or grievance is available in several places. Look at the Standard Appeal Packet sent to you at enrollment (see below to view or download). Also check your Explanation of Benefits (EOB) document, monthly health statement, and any precertification denial letter. All of these documents have information telling you where to file your initial appeal or grievance request. The customer service section of your benefit plan booklet also has contact information for the appeals and grievances offices for both BCBSAZ and any delegated vendors serving your plan. Use these resources and the guidelines to understand the steps you must take to dispute a decision. The guidelines also include optional forms you and your provider may use to file an appeal or grievance. If you still have any questions about appeals and grievances after reviewing these materials, please call AZ Blue customer service for help at the number on the back of your member ID card.

More information and forms:

AZ Blue Member Appeal/Grievance Packet  – for most commercial group plans and grandfathered and grandmothered individual/family plans
ACA Member Appeal/Grievance Packet – for ACA individual/family plans

Self-Funded Group Appeal/Grievance Packet - for some self-funded employer groups, except those that have their own customized appeal packets, including:
• State of Arizona (group 30855; member ID prefixes SYD and S3Z)
• Teamsters (groups 31843 and 31844; member ID prefix TYW)
• U-Haul (group 026229; member ID prefix UHL) – see the member benefit book

Appeal/Grievance Request Form
Authorized Representative Designation Form
Provider Certification Form for Expedited Appeal