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Hello, There is not a form that is needed to file an appeal. You can submit a letter explaining what you are appealing along with all supporting documentation to this address:
Blue Cross and Blue Shield of Texas - Appeals Department
PO Box 660044
Dallas, TX 75266-0044
If there is anything we can help you with please send us a private message. ~ Kayla
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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