Prescription Coverage Appeals, Complaints and Grievances Callback Form

If you have a Blue Cross Blue Shield of Michigan Medicare plan that covers prescription drugs, use this form to have us call you about an appeal, complaint or grievance you have related to your drug coverage.

Fields with asterisks are required.

First Name* This field is required.

Last Name* This field is required.

Home Address

City

Email* This field is required. This is not a valid Email.

Phone* This field is required. This is not a valid Phone Number.

Are you contacting us about:

Asking us to cover a prescription drug (coverage determination).

Appealing a decision we made.

A complaint related to prescription drug coverage or a pharmacy.

When is the best time to call you?

8 a.m. to noon

Noon to 5 p.m.

5 to 8 p.m.

This field is required.

Do you prefer email or a phone call?

Phone call

This field is required.

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Page Last Updated Fri Dec 27 12:12:18 EST 2024