Exceptions and appeals

Know the process to ask for a change

Whether you are a Medicare member or receive insurance through your employer, you have the right to ask for an appeal, file a grievance, or appoint a representative.

Medicare

Part D coverage redetermination

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

Medicare

Part C coverage redetermination

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 time frame could seriously jeopardize the life or health of the member, you may request an expedited appeal.

Medicare

Grievances

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

Medicare

Appoint a representative

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

Insurance through an employer

Exceptions and appeals

If you receive insurance through your employer, visit this page to learn how to file a grievance or appeal and seek a representative.

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