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Coverage Decisions & Appeals
Coverage decisions are decisions we make about whether a service is covered by the plan and the amount, if any, we are required to pay for the service. Coverage decisions are also called organization determinations. If you are not satisfied with the outcome of a coverage decision, you can appeal the decision by requesting a plan reconsideration. Learn more about coverage decisions and reconsiderations, and filing grievances. Call a customer service representative to get an aggregate number of grievances and appeals filed with BlueCross Total.
To request a coverage decision or reconsideration:
- Call 1-855-204-2744 (TTY 711)
- Fax your request to 1-803-264-9581
- Email your request to email@example.com
- Download a reconsideration request form
You can name another person to act as your “representative” and ask for a coverage decision or reconsideration on your behalf, such as a friend, relative, doctor or other prescriber. To have a representative act on your behalf, both you and the representative must sign the Appointment of Representative form.
More Important Information
- LIS Premium Summary Chart
- Multi-Language and Non-Discrimination Policy
- Beneficiary Rights and Responsibilities Upon Disenrollment
- Our Privacy Practices
How to Contact Us
To Enroll: 1-800-930-2836 (TTY 711). Calls to this number are answered by a licensed insurance agent
Already a Member: Call our Customer Service representatives at 1-855-204-2744 between 8 a.m. – 8 p.m. (Eastern Time), seven days a week.
Address: Medicare Advantage, BlueCross BlueShield of South Carolina, P.O. Box 100191, Columbia, SC 29202-3191
Provider Services: 1-855-209-7267
Prior Authorization Fax: 1-803-264-6552
Mental Health: 1-800-868-1032