Appeals & Grievances

To file an appeal, complete this form and mail it to:

CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD)
Attention: Appeals & Grievance Department
PO Box 915
Owings Mills, MD 21117

You may call Member Services at 410-779-9369 or 800-730-8530 if you need help completing the form.

For Level I Appeals, forms must be received within 90 days of the date on the letter you received saying that we wouldn’t cover the service you wanted.

For Level II Appeals, forms must be received within 15 days from the Level I Appeal outcome letter date.

When you file an appeal, be sure to let us know any new information that you have that will help us make our decision. We will send you a letter informing you that we received your appeal within 5 business days of receipt in the company. While your appeal is being reviewed, you can still send or deliver any additional information that you think will help us make our decision.

Your doctor can also file an appeal if you sign a form giving them permission. Other people can also help you file an appeal, like a family member or a lawyer, when they file an Appointment of Representative Form, allowing them to file on your behalf.

Expedited Appeals

If your doctor or CareFirst CHPMD feels that your appeal should be reviewed quickly due to the seriousness of your condition, this is called an expedited appeal. A CareFirst CHPMD Medical Director will review the request and determine if your issue is life-threatening. You will receive a decision about your appeal within 72 hours. You may call or ask us in writing for an expedited appeal.

If we do not feel that your appeal needs to be reviewed quickly, we will try to call you and send you a letter letting you know that your appeal will be reviewed within 30 days.

Our review process

When reviewing your appeal, we will:

• Use doctors who know about the type of illness you have
• Not use the same people who denied your request for a service
• Make a decision about your appeal within 30 days

The appeal process may take up to 44 days if you ask for more time to submit information or if we need additional information from other sources. We will send you a letter if we need additional information.

If your appeal concerns a service already authorized and you were already receiving, you may be able to keep getting the service while we review your appeal. Contact us at 410-779-9369 or 800-730-8530; TTY 711 if you want to keep getting services while your appeal is reviewed. If you do not win your appeal, you may have to pay for the services you received while the appeal was being reviewed.

Once we complete our review, we will send you a letter letting you know our decision. If we decide you should not receive the denied service, that letter will tell you how to file another appeal or ask for a State Fair Hearing.