What are the members appeal and grievance rights?
What is an appeal or grievance? An “appeal” is the type of complaint you make when you want us to reconsider and change a decision we have made about what services or benefits are covered for you or what we will pay for a service or benefit. For example, if we refuse to cover or pay for services you think we should cover, you can file an appeal. If VNS CHOICE Medicare or one of our plan providers refuses to give you a service you think should be covered, you can file an appeal. If VNS CHOICE Medicare or one of our plan providers reduces or cuts back on services or benefits you have been receiving, you can file an appeal. If you think we are stopping your coverage of a service or benefit too soon, you can file an appeal. There are different time frames and terms that VNS CHOICE Medicare uses when we receive an appeal, depending on whether the appeal concerns your prescription drug coverage or your other Medicare services. Please see below for specific information about how your appeal w
