Information on where and how to file an appeal or grievance is available in several places. Look at the BCBSAZ Appeal and Grievance Guidelines sent to you at enrollment. 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 guideline also includes 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 BCBSAZ customer service for help at the number on the back of your member ID card.

Member Dispute Forms

• BCBSAZ Appeal and Grievance Guidelines
• Appeals Request form
• Authorized Representative Designation Form
• Provider Certification Form for Expedited Appeal