*Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
For additional information on coverage determinations (including exceptions), grievances and appeals processes, please refer to the Evidence of Coverage.
Appointing a Representative
If you want a friend, relative, your doctor or other provider, or other person to be your representative, you will need to complete the Appointment of Representative form. This will give that person the ability to act on your behalf. The form must be signed by you and by the person who you would like to act on your behalf. You must give us a copy of the signed form.
Obtaining a Coverage Decision
Members of BlueJourney PPO and BlueJourney HMO may ask us to make a coverage decision about a service or drug. To request an expedited coverage decision about your medical care, please contact BlueJourney HMO at 800.779.6962 or BlueJourney PPO at 866.987.4213 (TTY: 711). To request an expedited coverage decision for a Part D drug, please contact CVS/caremark - 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
PO Box 52000, MC109
Phoenix, AZ 85072-2000
Attention: PA Department
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.
Updated April 3, 2017
Y0016_17_400 Approved 10052016