How to File Complaints Against Blue Cross Blue Shield

When there is a dispute in the correct handling of an insurance claim with a company such as Blue Cross Blue Shield, it may seem a daunting task to prove your case. If working with management has not resolved the issue, consumers can then move on to the appeal process with Blue Cross, as well as outside mediation. If these venues fail to produce the desired results, the next course of action is to take it to the agency in your state that oversees all insurance companies.

Instructions

• 1

  Gather all the information you have regarding the situation that is causing the complaint against Blue Cross, including all medical bills, the medical policy's explanation of what it covered for this situation, benefit explanations from Blue Cross as to what was paid, any correspondence regarding a denial, and all information from the appeal and mediation process.

• 2

  Contact your state's Department of Insurance to file a formal complaint against Blue Cross Blue Shield. Each state has different laws and requirements regulating how this will be done. The National Association of Insurance Commissioners (NAIC.org) provides a direct link to your state's website and the forms necessary to begin the complaint process. Provide as much information as you can on the online form.

• 3

  Provide copies of the information you have gathered to the state Insurance Commissioner with a letter explaining why you are filing the complaint. If you are mailing it, you may wish to send it certified or registered to make sure it arrives at the proper office. If you have not heard from anyone within 3 to 5 days of the office's expected receipt of the paperwork, call to find out who has been assigned to your case, and to obtain the case or file number.

• 4

  Keep a notebook and pen handy to record the names of anyone you speak with regarding this matter, and the gist of the conversation. This can assist you in avoiding a missed deadline for additional paperwork; however, it can also protect you if someone fails to advise you to submit something, or gives you the wrong information.

• 5

  Follow up every 3 to 4 weeks with your caseworker to check on the status of the complaint; keep a written record of the conversation in your notebook. Provide any additional information that the Insurance Commissioner's office may need to investigate. The process can take several months before a determination is made.