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Verify Benefit Coverage
We strongly encourage members to ask their provider to check Regence's website or call us to verify benefit coverage before services are provided. Members may also call Regence for any questions about whether a service is a covered benefit.
Complete and submit this online fillable form. Your concerns and comments are important to us. If you have concerns about a clinic, doctor or other health care professional, we’d like to hear from you.
Appeal and Grievance Process
What is an Appeal?
An "Appeal" is a written or oral request from a Member or, if authorized by the Member, the Member's Representative, to change a previous decision made by Regence BlueShield of Idaho concerning:
- Access to health care benefits, including an adverse determination made pursuant to utilization review,
- Claims payment, handling or reimbursement for health care services, or
- Matters pertaining to the contractual relationship between a Member and the plan, or
- Other matters as specifically required by State law or regulation.
Who is a "Member"?
"Member" is the enrolled employee or contract holder or his/her enrolled dependent.
Who is a "Member Representative"?
"Member Representative" is any authorized representative of the Member.
Member Appeals Process
When members have concerns about the processing of a claim or other action by Regence BlueShield of Idaho and wish to have it reviewed, they or their representative may appeal within 180 days of receiving our written determination—such as an explanation of benefits or a letter denying a pre-authorization request. Appeals may be made either verbally or in writing.
All appeals are reviewed by appropriate Regence BlueShield of Idaho staff who were not involved in previous determination(s) and are responded to in writing. For members who need a faster process and whose appeal qualifies, there is an expedited appeal process. Following the internal process, an independent, external review may be available for certain matters. The appeal process varies by type of plan in order to comply with state and federal law. Details are available in the member's benefit book.
If you have any questions, please contact our Customer Service department at (208) 746-2671 or toll-free at 1 (800) 632-2022. If you want additional information regarding privacy at Regence BlueShield of Idaho, please refer to our Notice of Privacy Practices at www.regence.com/legal/notice-of-privacy-practices.jsp.
Download a printable copy of our appeal process notice (PDF) that includes government resources to turn to if you are not satisfied with our assistance, or if you have additional questions about this notice or your appeal rights.
Agent Bonus/Commission Notice
If you have a broker or agent, they may receive bonuses, commissions, administrative services, or other compensation, from Regence. Incentives may be based on any of several factors, including the size of group business, the products you buy, your broker or agent's volume of business with Regence and the other services your agent or broker provides to you. These incentives may have an indirect impact on your rates. For more information, please contact your broker or agent.