How do I appeal a claim payment or denial?If I am dissatisfied with the resolution through the formal grievance process, what are my remaining options?
A57.You may file an appeal with Anthem Blue Cross. Call us at the Customer Service number shown on your Member ID Card. Your issue may then become part of our formal grievance process and will be resolved accordingly. If you are dissatsified with the resolution through the formal grievance process, you may submit your grievance to the California Department of Managed Health Care(DMHC)for review. If your case involves an imminent threat to your health including, but not limited to, the potential loss of life, limb or major bodily function, you may not be required to complete the Anthem Blue Cross appeal process or to wait at least 30 days, but may immediately submit your grievance to the DMHC for review. You may be eligible for an independent medical review which is handled through the DMHC and a contracted independent medical review organization. In addition, you may at any time pursue other dispute remedies which may include Small Claims Court or Binding Arbitration.
