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Coverage Decisions, Appeals and Grievances

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Process for Medicare coverage requests, appeals & complaints

We want to be your first stop if you have a concern about your coverage or care. Call us at the number on your member ID card. 
 

As ${anCompany} Medicare member, you have the right to:

  • Ask for coverage of a medical service or prescription drug. In some cases, we may allow exceptions for a service or drug that is normally not covered. 
  • File an appeal if your request is denied. An appeal is a formal way of asking us to review and change a coverage decision we made.  
  • File a complaint about the quality of care or other services you get from us or from a Medicare provider.
  • Appoint someone else to act on your behalf. How to appoint a representative


There are different steps to take based on the type of request you have.

Choose a topic to help us find the right process for you