What’s important to you is important to us. If you are ever dissatisfied with any aspect of our plans, please let us know. We have a process in place to make sure we resolve your concerns as quickly as possible.
Your first step
If you have a complaint or a problem, call us right away. We may be able to resolve your complaint or approve a request over the phone.
You may also refer to Chapter 7 or Chapter 9 in your Evidence of Coverage, titled: What to do if you have a problem or complaint (coverage decisions, appeals, complaints).
Grievance Process (link to page)
You have the right to make a complaint if you have concerns or problems related to your coverage or care. An example of a grievance would be dissatisfaction with waiting times when you fill a prescription, the way your plan pharmacist or others behave or the cleanliness of a plan pharmacy.
Coverage Determinations (link to page)
We will make what’s called an "initial decision," and explain whether we will provide the prescription drug you are requesting or pay for one already received.
Appeals (link to page)
If we deny your request for coverage, payment or for an exception, you have the right to request an appeal, also called a redetermination. To make that request, use this form: Request for Redetermination of Part D Drug Denial (requires Adobe Reader).(link away)
Appointing a Representative (link to page)
To obtain an aggregate number of grievances, appeals and exceptions filed with the plan, contact us.
You have the right to appoint someone to act on your behalf and request a coverage determination.