What if I have a complaint?

Who is this for?

Learn more about contacting us when you have a complaint.

If you experience a problem related to quality of care, service or long wait times or if you have other concerns, this information will tell you how to let us know.

As a Medicare Advantage or Prescription BlueSM PDP member, you can always call us when you have a question, concern or complaint about your plan.

But for some situations, we have a formal complaint process in place. When you contact us with your complaint, it's also called filing a grievance.

What kinds of things are considered complaints?

If you have a concern related to:

  • Quality of care
  • Your right to privacy
  • Poor customer service
  • Long waiting times for appointments, on the phone, at your doctor’s office, etc.
  • Information you get from us
  • How long we take to respond to a coverage decision or appeal

You can find more information about complaints in your plan's Evidence of Coverage.

What else should I know about complaints?

  • Medicare guidelines give you 60 days to tell us after the problem occurs.
  • You can’t be disenrolled from your plan for contacting us with a complaint.
  • Your complaint will always be handled fairly and investigated following Medicare rules.

How do I contact you about a complaint?

The best way to start is by calling the customer service number on the back of your Blues ID card. We try to resolve the problem the first time we hear from you. If you’d rather write us, send a fax or fill out a form, find the situation below that applies to you and choose your plan type.

My complaint is about medical care or service, waiting time for medical appointments or other medical-related concerns.

My complaint is about pharmacy service, waiting time for a prescription or other pharmacy-related concerns.

If calling us isn’t convenient, all members can fill out our online callback form. Then we’ll get in touch at the best time for you. Select your plan below to find other ways to contact us.