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Member Appeal Request Information

If you do not agree with a decision made by Preferred Care Partners regarding a request for coverage or payment of services, you can download the form below and follow the steps listed to file your appeal.

  1. Download the Member Appeal Request form
  2. Include copies of documents that help support the appeal.
  3. Mail or fax completed form and documentation to:

Grievance And Appeals Department- Part C

Mail

Appeals and Grievance Department
PO Box 6106, MS CA 124-0157, Cypress, CA 90630-0016

Fax

Standard Appeal: 1-888-517-7113
Expedited Appeal: 1-866-373-1081

Grievance And Appeals Department- Part D

Mail

Part D Appeals and Grievance Department
PO Box 6106, MS CA 124-0197,  Cypress, CA 90630-0016

Fax

Standard Appeal: 1-866-308-6294
Expedited Appeal: 1-866-308-6296

As a member of our plan, you have the right to get several kind of information from us. This includes information about the number of appeals made by members and the plan's performance rating including how it has been rated by plan members and how it compares to other Medicare Advantage health plans. To file a complaint directly to CMS. link https://www.medicare.gov/MedicareComplaintForm/home.aspx

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.


Phone

1-866-231-7201 (TTY 711) Calls to this number are free.
Hours of Operation: 8 a.m. - 8 p.m. local time, 7 days a week.
Customer Service also has free language interpreter services available for non-English speakers.

Mail

Preferred Care Partners, Inc.
P.O. Box 30770, Salt Lake City, UT 84130-0770

Walk In

9100 S. Dadeland Blvd, Suite 1250
Miami, FL 33156
9 a.m. - 5 p.m., Mon - Fri

2020 Evidence of Coverage (EOC)


Click here for 2019 Evidence of Coverage