Exceptions and appeals

If you have received an unfavorable Part D coverage redetermination, you can ask for a redetermination (appeal).

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

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

If you are dissatisfied with any aspect of your Medicare plan, Customer Care, your provider or treatment facility, you can submit a grievance.

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

If you’re unhappy with some aspect of your coverage, you can file a grievance or appeal and seek a representative to act on your behalf.

You may be able to ask for a reconsideration if the Centers for Medicare and Medicaid Services (CMS) required you to pay a late enrollment penalty when you enrolled in Medicare Part D.