Medical Frequently Asked Questions for Individual Members
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Step 1: Contact Us
Call the Member Services phone number on your member ID card. If your concern is not resolved via a call with a CareFirst representative, you may submit a written appeal.
Step 2: Submit a Written Appeal
CareFirst must receive your written appeal within 180 days or six months of receiving the written notification of claim denial. Send it to Mail Administrator, P.O. Box 14114, Lexington, KY 40512. If you prefer, you can send a secure email with your request through My Account.
In the letter include:
- Member name and ID number
- Provider name
- Date(s) of service
- Admission and discharge date (if applicable)
- A copy of the original Explanation of Benefits, voucher or bill
- Medical records (Emergency room records, X-rays, etc.)
Step 3: Appeal Decisions
All appeal decisions will be sent to you in writing and will include a detailed explanation about the decision, as well as any documentation to support the decision. You will also receive information on next steps you may take if you are not satisfied with the appeal decision.
Learn more about this process.
- Members who bought ACA Plans directly from CareFirst (off exchange): 855-444-3122
- Members who bought ACA Plans through an Exchange or Marketplace (on exchange): 855-444-3121
- Members with Grandfathered/Non-ACA* Plans: 800-722-2467
- Medigap Members: 800-722-2235
* Grandfathered coverage is coverage that was purchased prior to March 23rd, 2010, when the Patient Protection and Affordable Care Act went into effect.