Exceptions and complaints

Step one:

If you have a concern, call Customer Service. We might be able to answer your question or resolve your concern over the phone.

Step two:

Ask for an exception for prescription drugs

(Coverage determination)

Request a coverage decision for medical services

(Organization reconsideration)

Or, file a complaint/grievance about service

 

Ask for an exception for a drug that you believe should be covered by your plan. Learn how to appeal if our decision is not in your favor.
Exception instructions
Formally request a coverage decision for medical services that you believe should be covered by your plan. Learn how to appeal if our decision is not in your favor.
Coverage decision instructions
Make a complaint (or grievance) about the service(s) you receive from us or from our network of doctors, hospitals, pharmacies and other health care providers.
Service complaint instructions

To file a complaint directly with Medicare, use their complaint form on medicare.gov.

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.