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Grievances and Appeals

For BlueJourney HMO and BlueJourney PPO Members

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You can file a grievance if you’re unhappy with our service, plans or providers. You can also appeal a denial of payment, eligibility or other decision.

Please see your BlueJourney PPO Evidence of Coverage or BlueJourney HMO Evidence of Coverage for details.

Appointing a Representative

To select a representative, complete the Appointment of Representative form. Your representative will be able to act for you. You and the representative must sign the form. We will need a copy of the signed form.

Obtaining a Coverage Decision

Members of BlueJourney PPO and BlueJourney HMO can ask for a coverage decision about a service or drug. To request a rushed coverage decision, please contact BlueJourney HMO at 800.779.6962 or BlueJourney PPO at 866.987.4213 (TTY: 711). To request a rushed coverage decision for a Part D drug, please contact CVS/caremarkTM - BlueJourney HMO at 800.844.0719 or BlueJourney PPO at 800.861.1737 (TTY: 711).

Standard coverage decisions must be in writing. Please send these requests to:

BlueJourney HMO Organizational Determinations (or) 
BlueJourney PPO Organizational Determinations 

PO Box 773733 
Harrisburg PA 17177-3733

CVS/caremark 

Attention: PA Department 
PO Box 52000, MC109 
Phoenix, AZ 85072-2000

Obtaining Data on Exceptions, Appeals and Grievances

Members of BlueJourney PPO and BlueJourney HMO can receive a description of the plans’ total number of exceptions, appeals and grievances received and how these cases were resolved. Contact BlueJourney PPO and BlueJourney HMO by phone or in writing.

BlueJourney HMO Organizational Determinations (or) 
BlueJourney PPO Organizational Determinations 

PO Box 773733 
Harrisburg PA 17177-3733

CVS/caremark 

Attention: PA Department 
PO Box 52000, MC109 
Phoenix, AZ 85072-2000

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Updated October 1, 2017

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