Grievances, appeals and determinations
What’s important to you is important to us. If you’re ever dissatisfied with any aspect of your plan, please contact us so we can resolve your concerns quickly.
Ways to resolve concerns
You have several options to address and resolve any concerns you have with your health plan, including:
If we deny your request for coverage, payment or an exception, you have the right to request an appeal.
You or your doctor can request a Formulary Exception if a drug your doctor prescribes is not on our drug list, or if the drug is subject to one of our utilization management requirements, such as step therapy or quantity limits.
A drug that is not on our drug list that we approve through the Formulary Exception Process will be considered a nonpreferred generic (Tier 2) or nonpreferred brand (Tier 4) drug.
When we make an initial decision about a prescription drug or medical service, we’ll explain whether we’ll provide the drug or service you are requesting or pay for the one you are already received.
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You have the right to make a complaint when you experience problems with quality of care, customer service, long wait times and other issues not related to your plan coverage.
If you have a complaint or a problem, contact us. We may be able to resolve your complaint over the phone. You can also contact us for information on how to obtain an aggregate number of grievances, appeals and exceptions filed with HAP.