Members Can Appeal Coverage Decisions

Members Can Appeal Coverage Decisions

Members Can Appeal Coverage Decisions
Internal Appeals

Blue Cross and Blue Shield of Illinois (BCBSIL) has an internal claims and appeals process that allows you to appeal decisions about paying claims, eligibility for coverage or ending coverage.

Please check “adverse benefit determination” in your benefit booklet for instructions.

External Appeals

If your internal appeal is denied, in some cases you may request an external review. External review is an option for denials for services that were not medically necessary or were clinically unproven.

As a BCBSIL HMO member, you may have these types of denials examined by external, independent reviewers. The independent review organization is not associated with your health plan. There is no charge for requesting the review.

We will send you information reminding you that independent, external review of coverage is available every year. We mail the information to members who do not have fax, email or internet access.

Call the customer service number on your member ID card if you have questions about the external review process.

Find Tools and Resources

Log in to Blue Access for MembersSM, our secure member website, for a personalized search experience based on your health plan and network. Learn more about your benefits and gain access to member services. Get coverage details, access resources and tools, and more. You can also find doctors in your network, get an ID card, and sign up for text or email notifications, tips and reminders.

Originally published 10/14/2019; Revised 2020, 2022, 2023