Grievance/IRO Notice

You may ask for more details about your request for benefits and/or decision.  If applicable, you may ask for diagnosis and treatment codes and their descriptions.  You may also send us a letter asking for the facts we looked at to make our decision and we will send these facts to you for free.  You can call Member Service at the number on the back of your BlueCross BlueShield of Tennessee ID card to ask for the details or facts about your claim(s).   

If you do not agree with a decision, you may ask us to review it.  This is called a “grievance” or “appeal” in your Evidence of Coverage or plan materials.  Please read the grievance/appeal section in your Evidence of Coverage or plan material.  Every member has access to an appeals/grievance process. Some plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA), which is a Federal Act with specific appeal/grievance rights.  If your health plan is governed by ERISA, you may file a civil action after you finish the grievance/appeal process.  You may also be able to ask for an independent review of a decision.  If your plan is not governed by ERISA you will have appeal/grievance rights outside of ERISA.  Please refer to your plan materials for your rights.  To begin the process or if you are unsure of your rights, call Member Service at the number on your ID card. 

When filing a grievance/appeal, you can use a representative such as a lawyer, or you can file the grievance/appeal by yourself.  You can send us additional information for the review.  You must send us your grievance/appeal before 180 days (unless otherwise stated in your Evidence of Coverage or plan materials) have passed from the date you receive your Explanation of Benefits or notice, unless otherwise stated in your Evidence of Coverage or handbook.  BlueCross BlueShield of Tennessee will give you an answer within 15 to 60 days, depending on your health benefit plan rules.  If your request is related to an urgent care need, we will review your claim and provide an answer within 72 hours.  You may also begin an external review at the same time as the internal appeals process if the request is an urgent care situation or you are in an ongoing course of treatment. 

Non-Federal Governmental Fully Insured and Self-funded Plans:  For questions about your rights or for assistance, you may contact the U.S. Department of Health and Human Services Health Insurance Assistance Team (HIAT) at 1-888-393-2789.  Only concerning members of the State of Tennessee Insurance Program, including the State of Tennessee employee plan, higher education, local education and local education and local government plans:  You may also contact the State Division of Benefits Administration at 1-866-576-0029 for additional information about your options. 

All other Self-funded Plans:  For questions about your rights or assistance, you may contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) at 1-866-444-EBSA (3272) or www.askebsa.dol.gov

All other Fully Insured Plans:  For questions about your rights or for assistance, you may contact the Tennessee Department of Commerce and Insurance (TDCI) at 1-800-342-4029, or via mail at 500 James Robertson Pkwy, Davy Crockett Tower, 6th Floor, Nashville, TN 37243.  You may submit information electronically by completing a complaint form at the following webpage: 

English Version:  https://sbs-tn.naic.org/Lion-Web/servlet/org.naic.sbs.ext.onlineComplaint.OnlineComplaintCtrl?spanishVersion=N

Spanish Version: https://sbs-tn.naic.org/Lion-Web/servlet/org.naic.sbs.ext.onlineComplaint.OnlineComplaintCtrl?spanishVersion=Y

If you are not sure which assistance program to contact, you may call Member Service at the number on your BlueCross BlueShield of Tennessee ID card.  BCBST language and member services are free at 1-800-565-9140, Monday – Friday, 8 a.m. to 5:15 p.m. Easter Time.  For TDD/TTY help call 1-800-848-0299. 

Spanish: Para obtener asistencia en Español, llame al (800) 494-338

Tagalog: Kung kailangan ninyo ang tulong sa Tagalog tumawag sa (800) 494-3384


Chinese: 如果需要中文的帮助,请拨打这个号码 (800) 494-3384

Navajo: Dinek'ehgo shika  at'ohwol  ninisingo, kwiijigo  holne' (800) 494-3384

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