Appeals and Grievances
For Capital Blue Cross HMO and Capital Blue Cross PPO Members
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 Capital Blue Cross PPO evidence of coverage or Capital Blue Cross 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 Capital Blue Cross PPO and Capital Blue Cross HMO can ask for a coverage decision about a service or drug. To request a rushed coverage decision, please contact Capital Blue Cross HMO at 800.779.6962 or Capital Blue Cross PPO at 866.987.4213 (TTY: 711).
Standard coverage decisions must be in writing. Please send these requests to:
Capital Blue Cross HMO Organizational Determinations (or)
Capital Blue Cross PPO Organizational Determinations
PO Box 779970
Harrisburg PA 17177-9970
Attention: PA Department
2900 Ames Crossing Road
Eagan, Minnesota 55121
Obtaining Data on Appeals and Grievances
Members of Capital Blue Cross PPO and Capital Blue Cross HMO can receive a description of the plans’ total number of appeals and grievances received and how these cases were resolved. Contact Capital Blue Cross PPO and Capital Blue Cross HMO by phone or in writing.
Capital Blue Cross HMO Appeals and Grievances (or)
Capital Blue Cross PPO Appeals and Grievances
PO Box 779970
Harrisburg, PA 17177-9970
If you need help filing an appeal, you can call member services, Monday through Friday, 8:00 AM to 8:00 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).