As a member of a Priority Health Medicare Advantage plan you, or your appointed representative, have the right to access the following processes:
- File a grievance (complaint)
- Request a determination for coverage
- File an appeal
These processes have been approved by Medicare, and each process has a set of rules, procedures, and deadlines that must be followed by us and by you. Additional details can be found in Chapter 9: If you have a problem or complaint (coverage decisions, appeals, complaints) of your plan’s Evidence of Coverage. If you have questions or need assistance with these processes, you can call the Customer Care team.
File a grievance
| Grievance (Complaint) |
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Request a determination for coverage
File an appeal
| Drug Redetermination Medical Reconsideration | Request Priority Health to reconsider a determination for coverage when you disagree with the decision. Learn how.
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Grievance and appeal data requests: To find out the combined number of grievances and appeals for a reporting period, call the Customer Care team.
Appointment of Representative
If you want someone else, like a family member or friend, to act on your behalf, you can sign a form that makes the person your official “authorized representative.” Learn how.