How to file a Medicare appeal
Either an "appeal" or a "request for drug redetermination" is how you ask Priority Health to reconsider when your request for a Medicare coverage decision has been turned down. See below for how to file an appeal.
If you haven't formally asked for a coverage decision yet, go to instructions.
Making an appeal or requesting a drug redetermination
- There are five levels of this process.
- At each level, your request is considered again and a new decision made.
- The decision may be all or partly in your favor, or all against you.
- If you are unhappy with the decision, you may be able to ask for the next level.
Follow these steps:
- Decide if you want someone else, like a spouse, child, or friend, to make an appeal for you. This person will be your "authorized representative."
Go to the instructions for naming an authorized representative.
- Give us the reasons why you think we should reconsider our decision. Use one of these ways:
Medical appeals Requests for drug redeterminiations - Fill out our online form, or
- Write us a letter, or
- Print the Appeal form, complete it and fax or mail it to us:
- Appeal Form to appeal a medical service coverage decision (PDF)
Print this form, complete it and fax or mail it to us:
Request for Redetermination of Medicare Prescription Drug Denial (PDF)
- Submit your form online, or mail your letter or form (and your authorization for your representative to act for you, if any) to:
Priority Health Medicare Appeal Coordinator
1231 East Beltline NE
Grand Rapids, MI 49525
You can also deliver it in person, or call Customer Service for help.
- To check on the status of your appeal or to learn more about the appeals process, call Customer Service from 8 a.m. to 8 p.m., 7 days a week, at 888.389.6648. TTY users should call 711. See your "Evidence of Coverage" booklet (links below) for ways to ask for a "fast decision" or "72-hour decision."