Blue Cross Blue Shield of Michigan Mutual Insurance Company claim denials in Michigan: the federal figures
Blue Cross Blue Shield of Michigan Mutual Insurance Company denied 13.7% of in-network claims in Michigan — 177,498 claims out of 1,291,509. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Blue Cross Blue Shield of Michigan Mutual Insurance Company) | 140 | 34.3% |
| External review (independent) | 45 | — |
What Blue Cross Blue Shield of Michigan Mutual Insurance Company denies most
The most common denial reason recorded for Blue Cross Blue Shield of Michigan Mutual Insurance Company plans in Michigan is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 180,802 | 53.5% |
| Other reasons | 74,364 | 22% |
| Administrative reason | 36,619 | 10.8% |
| Member not covered | 35,096 | 10.4% |
| Provider out of network | 3,803 | 1.1% |
| Referral required | 3,237 | 1% |
| Benefit limit reached | 1,362 | 0.4% |
| Experimental or investigational | 1,287 | 0.4% |
| Not medically necessary | 1,132 | 0.3% |
What to do if Blue Cross Blue Shield of Michigan Mutual Insurance Company denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Blue Cross Blue Shield of Michigan Mutual Insurance Company overturned 34.3% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Blue Cross Blue Shield of Michigan Mutual Insurance Company. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Blue Cross Blue Shield of Michigan Mutual Insurance Company appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Blue Cross Blue Shield of Michigan Mutual Insurance Company's denial rate high?
13.7% against a national average of 16% across the plans in this dataset. It is at or below average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Blue Cross Blue Shield of Michigan Mutual Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.