Exceptions and appeals

Exceptions and Appeals

You have the right to ask us to review your care and reconsider our original determination of services. You have the right to file a grievance if you are dissatisfied with any aspect of the care you receive. And you have the right to appoint a representative to handle Medicare matters on your behalf.

Part D Coverage Redetermination

If you have received an unfavorable drug determination, you can ask for a redetermination (appeal).

Part C Reconsideration

If you have received an unfavorable Part C determination, you can ask for a reconsideration (appeal).

Medicare Expedited Appeals

If you believe that waiting for a decision under the standard timeframe could seriously jeopardize the life or health of the member, you may request an expedited appeal.

Medicare Grievance

If you have dissatisfaction with any aspect of your health care plan, customer care, your provider or treatment facility, you can submit a grievance. Grievances do not include claims or service denials, as those are classified as appeals.

Appointment of Representative

You have the right to appoint a representative to act on your behalf.
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