Appeal a Determination
If we decide against your request for an initial determination regarding medical care or service or payment for service you received we will send you a written decision explaining why we denied the request. If the initial determination did not give you everything you requested you may file an appeal.
You will file your "Appeal Level 1" directly with our Member Services Department at 1340 Ridgewood Avenue, Holly Hill, FL 32117.
For appeals of requests for an initial determination regarding medical care or service or payment for services you received you must file your appeal within 60 days of the date after we notify you of our initial determination.
You may contact our Member Services Department at 386-615-4022 or 1-877-615-4022 to inquire about the status of your Appeal Level 1. From November 15 through March 2 of each year the hours of operation are 7 days a week, 8 a.m. to 8 p.m. From March 2 through November 14 of each year the hours of operation are Monday through Friday, 8 a.m. to 8 p.m. The hearing impaired may call TTY 1-877-260-8312.
Who may request an Appeal?:
The appeal must be requested by you, your prescribing physician, or someone you name/appoint. The person you name would be your "appointed representative." You may name a relative, friend, advocate, doctor, or anyone else to act for you. If you want someone to act for you who is not already authorized under State Law, then you and that person must sign and date an Appointment of Representative form that gives the person legal permission to be your appointed representative. This Appointment of Representative form must be included with your request for appeal.To access the document(s) Adobe Reader® must be installed on your computer. If you do not have Adobe Reader ®, you can download it for free by clicking here.
To obtain an aggregate number of Appeals filed with Florida Health Care Plans, please contact our Member Services Department at 386-615-4022 or 1-877-615-4022. From November 15 through March 1 of each year the hours of operation are 7 days a week, 8 a.m. to 8 p.m. From March 2 through November 14 of each year the hours of operation are Monday through Friday, 8 a.m. to 8 p.m. The hearing impaired may call TTY at 1-877-260-8312.
- Members of the Medvantage Plan please refer to Section 5 of your Evidence of Coverage for complete information regarding the appeals process and timeframes.
- Members of the Medvantage Rx & Rx Plus Plans please refer to Section 5 of your Evidence of Coverage for complete information regarding the appeals process and timeframes.
