You can contact us to make an Appeal about a Part D drug coverage decision also called a "redetermination."
You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for a coverage decision. If your health requires a quick response, you must ask for a "fast appeal." A "fast appeal" is also called an "expedited reconsideration." When we are using the fast deadlines, we must give you our answer within 72 hours after we receive your appeal. We will give you our answer sooner if your health requires it. If we are using the standard timeframe, we must give you our answer within 30 calendar days after we receive your appeal if your appeal is about coverage for services you have not yet received. We will give you our decision sooner if your health condition requires us to.
To file your appeal call toll free 1-866-231-7201 TTY users call toll-free 711, 8 a.m. - 8 p.m. local time, 7 days a week.
Standard Appeal: 1-866-308-6294
Expedited Appeal: 1-866-308-6296
Preferred Care Partners
Part D Appeal and Grievance Department
P.O. Box 6106
MS CA 124-0197
Cypress, CA 90630-9948
You or someone you name may file a grievance. The person you name would be your "representative." The grievance must be submitted within 60 days of the event or after incident you are complaining about. If something kept you from filing your complaint (you were sick, we provided incorrect information, etc.) let us know and we might be able to accept your complaint past 60 days. We will address your complaint as quickly as possible but no later than 30 days after receiving it. Sometimes we need additional information, or you may wish to provide additional information. If that occurs, we may take an additional 14 days to respond to your complaint. If the additional 14 days is taken, you will receive a letter letting you know.
You can file an expedited grievance whenever we do not provide a
"fast" decision about your initial request for a service, or your
request to appeal our denial of a service within 60 days of the
event or incident. If you are making a complaint because we
denied your request for a "fast coverage decision" or a "fast
appeal," we will automatically give you a "fast" complaint. If you
have a "fast" complaint, it means we will give you an answer within
24 hours. If you do not wish to call (or you called and
were not satisfied), you can put your complaint in writing and send
it to us. If you put your complaint in writing, we will
respond to your
complaint in writing.
Whether you call or write, you should contact Member Services right away.
1 (866) 231-7201 - Toll-Free
8 a.m. to 8 p.m.,
P.O. Box 29675
9100 S. Dadeland Blvd, Suite 1250
For detailed information on the process of filing a grievance or appeal and obtaining a coverage determination, refer to Chapter 9 of your Evidence of Coverage
Click on a link below to download a printable PDF.