Skip to main content
Text Size Default Font Size Medium Font Size Large Font Size Extra Large Font Size
Para el idioma Español
1-866-231-7201 (TTY - 711) Toll-Free
8 a.m. - 8 p.m. local time, 7 days a week
Call Us

Part D Appeal

 
You may file your Appeal or Grievance orally or in writing.

How to contact Preferred Care Partners when you are making an Appeal or Grievance about your Part D prescription drugs:

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:

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.

Or

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

Filing a Grievance

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.

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

 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


Evidence of Coverage (EOC) for 2020 plans

Click on a link below to download a printable PDF.