What is the difference between an appeal and a grievance?
Only complaints that deal with failure to cover the prescription you want, or payment for your prescriptions, are appeals. Any other type of complaint is called a grievance. Some examples of grievances are: long waiting times getting your prescriptions filled; poor hygiene conditions in a contracted pharmacy; or if you have problems with the plan’s service; or if you would like to dispute the plan’s decision to treat your request for an expedited exception, coverage determination, or appeal in the standard timeframe rather than the expedited timeframe. You can write or call with a grievance. To call, simply contact us. You’ll need to call within 60 days of the incident that you want to complain about. Write in with a grievance using the address below if that is what you prefer. Part D Appeals and Grievance Department PO Box 6106 M/S CA 124-0197 Cypress, CA 90630-9948 Grievances may also be faxed to 1-866-308-6294. We will investigate your case, and respond to you within 30 calendar day
Only complaints that deal with failure to cover the prescription you want, or payment for your prescriptions, are appeals. Any other type of complaint is called a grievance . Some examples of grievances are: long waiting times getting your prescriptions filled; poor hygiene conditions in a contracted pharmacy; or if you have problems with the plan’s service; or if you would like to dispute the plan’s decision to treat your request for an expedited exception, coverage determination, or appeal in the standard timeframe rather than the expedited timeframe. You can write or call us with a grievance. To call, simply contact our Customer Care Associates. You’ll need to call within 60 days of the incident that you want to complain about. Write in with a grievance using the address below if that is what you prefer. Part D Appeals and Grievance Department 5757 Plaza Drive M/S CA 124-0197 Cypress, CA 90630 Grievances may also be faxed to 1-866-308-6294. We will investigate your case, and respond
