All appeals for denied services are handled directly through Blue Shield of California.  For standard appeals the health plan has 30 days to review and for expedited appeals 72 hours.  A provider or patient may file an appeal.  An expedited appeal would be requested if it is determined that a delay in the decision making process might pose an imminent and serious threat to the patients health.  If it were determined by Blue Shield that an appeal meets this criteria, an expedited review would be done.  An appeal may be filed either by telephone or in writing.

To request an expedited appeal by telephone or in writing

Call the grievance and appeal unit at 1-877-665-6736 or fax your request to 925-543-9554.  The Grievance and appeal unit will document the verbal request in writing.

Please write to:

Blue Shield of California

Northern Grievance Resolution Department

P.O. Box 639018

Folsom, CA  95763-9018

The request must be submitted within 60 days of receipt of the denial.Note: In addition to the process described above, you may also contact the California Department of Managed Care (DMC).  The California Department of Managed Care is responsible for regulating health care plans.  The department has a toll free number (1-800-400-0815) to receive complaints regarding health care plans.   If you have a grievance against the health plan, you should first telephone the plan and use the plan’s grievance process before contacting the department.  If you need help with a grievance which has not been satisfactorily resolved, or has remained unresolved for more than 30 days, you may call the department for assistance.

IF YOU HAVE ANY QUESTIONS REGARDING THE AUTHORIZATIONS PROCESS, PLEASE FEEL FREE TO CONTACT THE KEY MEDICAL GROUP AT (559) 735-3892, 8 AM TO 5 PM MONDAY THROUGH FRIDAY.