Medicare Choices Grievance and Appeals

Grievance and Appeals

If You Have A Complaint

You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "grievances" are the two different types of complaints you can make.

An "appeal" is the type of complaint you make when you want us to reconsider and change a decision we have made about what prescription drug benefits are covered for you or what we will pay for a prescription drug.

A "grievance" is the type of complaint you make if you have any other type of problem with CDPHP Medicare Choices Plans or one of our network pharmacies.

Grievance and Appeals Process

You may file a grievance or appeal pertaining to either medical coverage or Part D prescription drug coverage. Please review the Appeals and Grievances Overview for a general description of the process for all CDPHP Medicare Choices plans. To read a complete description of our Appeals and Grievance Process for a specific plan, please refer to the plan's Evidence of Coverage.

• Grievance and Appeals Forms
• Appeals and Grievances Process Overview
• Prior Authorization and Medical Exception Form
• Instructions About How to Appoint a Representative
• Appoint a Representative Form
• Request for Medicare Prescription Drug Determination Request Form (for use by enrollees)
• Medicare Part D Coverage Determination Request Form (for use by providers)

For more information, please refer to your Evidence of Coverage or contact Customer Care for assistance.