Service issues

How to get help with PriorityMedicare coverage and service issues

Federal law guarantees that you can make a formal complaint if you have concerns or problems with any part of your care. The Medicare program has helped set rules about what you need to do to make a complaint, and what we are required to do when we receive your complaint.

• If you make a complaint, we must be fair in how we handle it.
• You can't be disenrolled from a PriorityMedicare^SM plan or penalized in any way if you make a complaint.

Call us first

If you have questions, concerns or problems with your PriorityMedicare plan or the care you receive, call Customer Service right away. They can help you get started with:

• Coverage exceptions
  Learn how to make a formal request for us to cover a drug or medical service that is not normally covered under your plan.
• Appealing our decisions about your coverage
  Learn how to ask us to reconsider our decision if it is not in your favor.
• Filing complaints (grievances) about service
  Learn how to complain about the service you receive from us or from our network of doctors, hospitals, pharmacies and other health care providers.

Information for providers

For process or status questions related to grievances or other issues, click here.

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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 the 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:
   
   PriorityMedicare Service Coordinator
   1231 East Beltline NE, MS 1165
   Grand Rapids, MI 49525
   
   You can also deliver it in person, or fax it to us at 616 975-8880 or 942-0995, or call Customer Service.

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Numbers of grievances and appeals

To obtain the combined number of grievances, appeals and exceptions filed with the plan, call Customer Service.

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