• Overview
• Grievances (Complaints)
  • Making a Complaint
• Problems/Concerns about Part C Medical Benefits and Coverage
  • Coverage Decisions
  • Appeal a Coverage Decision
• Problems/Concerns about the Part D Prescription Drug Benefit
  • Coverage Decision/Exceptions
  • Appeal a Coverage Decision

Medicare Appeals and Grievances

Click Here for 2012 Appeals and Grievances

To learn more about "How to file a Grievance/Make a Complaint" please click here.

To learn more about "What to do if you have problems/concerns about your Part C medical benefits and coverage" please click here.

To learn more about "What to do if you have problems/concerns about your Part D prescription drug benefit" please click here.

 

Forms:

Below are links to common forms needed for Medicare Part C & D Appeals and Grievances.

Medvantage Plan Evidence of Coverage (refer to Section 7 for Coverage Decisions, Appeals and Complaints)

Medvantage Rx Plan Evidence of Coverage (refer to Section 9 for Coverage Decisions, Appeals and Complaints)

Medvantage Rx Plus Plans Evidence of Coverage (refer to Section 9 for Coverage Decisions, Appeals and Complaints)

Appointment of Representative

FHCP’s Request for Medicare Prescription Drug Coverage Determination (to assist the member in requesting a Part D Coverage Determination)

Medicare Part D Coverage Determination (to assist the provider in requesting a request for Exception of Prior Authorization on behalf of their patient)