Appeal Guidelines for Banner Health and Dental Plans
If you have received a denial, please send in a written request stating what you are appealing. For your appeal to be processed, the following information must be included:
- Patient name
- Patient ID
- Mailing address
- Contact phone number
- Type of appeal: Benefit (all issues except medical or dental claims) or Health Care (claim denials for medical or dental plans)
- Reason for appeal (Full details)
- Date of service and amount (if applicable)
- Claim or authorization reference number (if applicable)
- Be sure to include any other information to support your request for appeal
For Choice Plus or Select medical plans and all dental plans, submit your letter of appeal and supporting documentation:
Banner Plan Administration
ATTN: Benefit Appeals (or Health Care Appeals)
P.O. Box 16423
Mesa, AZ 85211‐6423
Or fax to:
Benefit Appeals: (480) 684‐6966
Include “ATTENTION: Benefit Appeals” on the cover sheet.
Health Care Appeals: (480) 684-5911
Include “ATTENTION: Health Care Appeals” on the cover sheet.
If you are filing this appeal on behalf of someone else who is over the age of 18 years, please have them sign and date the Authorization to Use or Disclose Protected Health Information Form. Due to HIPAA regulations, we cannot process an appeal without this signed form.
View the Plan Documents for more information, or contact If you need help with your appeal or have questions about the appeal process, please call the Service Center at (480) 684‐7070 in the Phoenix metropolitan area or (800) 827-2464 for all other areas.
For Banner Health Savings medical plan, mail your letter of appeal and supporting documentation to:
Blue Cross Blue Shield of Arizona
ATTN: Banner Health Savings Plan / Claims Appeals
P.O. Box 2924
Phoenix, AZ 85062-2924
View the Plan Documents for more information, or contact Blue Cross Blue Shield at (855) 801-4637.
If you are filing an appeal with Blue Cross Blue Shield on behalf of someone else who is over the age of 18 years, the individual will need to sign an Authorized Representative Designation form, which you can request from Blue Cross Blue Shield. Due to HIPAA regulations, the appeal cannot be processed without this signed form.