Exceptions & complaints

The instructions here are for members of Priority Health Medicare Advantage and Prescription Drug Plans.

The Medicare program has rules about what members of Priority Health Medicare plans need to do to ask for exceptions or make complaints about their coverage or their service, and how we must handle their requests and complaints.

• We must be fair in how we handle it.
• You can't be disenrolled from a Priority Health Medicare plan or penalized in any way.

Step one: Call us!

Whatever you need, call Customer Service right away. We might be able to resolve your question or concern or approve your request over the phone.

Step two:

Naming someone to help you

If you want someone else, like a spouse, child or friend, to act for you when you make a complaint or appeal a decision, you can sign a form that makes that person your official "authorized representative." Here's how:

1. Print our Appointment of Representative form. (120KB PDF)
   OR Medicare's appointment of representative form (120KB PDF)
2. Write in the name of the person you want to act for you. Sign and date the form.
3. Have your representative sign and date the form.
4. Mail the form to us at:
   
   Priority Health Medicare Coordinator
   1231 East Beltline NE, MS 1115
   Grand Rapids, MI 49525
   
   You can also deliver it in person at these locations, or fax it to us at 616 975-8826, or call Customer Service.

More details about filing exception requests and complaints

To better understand the services you are entitled to under your Priority Health Medicare plan, including more details about asking for coverage exceptions and filing a complaint, you can refer to the "Evidence of Coverage" booklet for your plan.

• 2012 PriorityMedicare Value Evidence of Coverage (1.75MB PDF) Instructions are in Chapter 9.
• 2012 PriorityMedicare Evidence of Coverage (1.75MB PDF) Instructions are in Chapter 9.
• 2012 PriorityMedicare Select Evidence of Coverage (1.76MB PDF) Instructions are in Chapter 9.
• 2012 PriorityMedicare Rx Evidence of Coverage (1.2MB PDF) Instructions are in Chapter 7.

Information for health care providers

Here's who to contact for process or status questions related to grievances or other issues.
Go to the provider contacts listing.

To request authorization for Part D drugs, use the Medicare Coverage Determination form (254KB PDF).

Numbers of grievances and appeals

To find out the combined number of grievances, appeals and exceptions filed with Priority Health Medicare plans, call Customer Service.