Appeals and Grievances

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.

• Member Appeal and Grievance Form
• Reference Guide for Filing an Appeal
• Reference Guide for Filing a Grievance
• Request for Medicare Prescription Drug Determination
• Request for Redetermination of Medicare Prescription Drug Denial
• Medicare Complaint Form
  

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). 

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

BlueJourney HMO Organizational Determinations (or) 
BlueJourney PPO Organizational Determinations 

PO Box 779970 
Harrisburg PA 17177-9970 
Fax: 1.888.456.2449

Prime Therapeutics 

Attention: PA Department 
2900 Ames Crossing Road
Eagan, Minnesota 55121
Fax: 1.800.693.6703

Obtaining Data on Appeals and Grievances

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

BlueJourney HMO Appeals and Grievances (or) 
BlueJourney PPO Appeals and Grievances 

PO Box 779970  
Harrisburg, PA 17177-9970

Need Help?

If you need help filing an appeal, you can call member services, Monday through Friday, 8 am to 8 pm, at 866.987.4213 with extended hours October 1 through March 31. On weekends and holidays, your call may be forwarded to our secure voice messaging system (TTY 711).