A grievance is a formal complaint you may file with the plan. Grievances do not involve problems related to approving or paying for Medicare Part D drugs.
Some types of problems that might lead to filing a grievance include:
- Issues with the service you receive from us.
- If you feel that you are being encouraged to leave (disenroll from) our plan.
- If you disagree with our decision not to give you a "fast" decision or a "fast" appeal.
- We don't give you a decision within the required time frame.
- We don't give you required notices.
- You believe our notices and other written materials are hard to understand.
- Waiting too long for prescriptions to be filled.
Who may file a grievance
You or someone you name may file a grievance. The person you name would be your "representative." Your representative may be a relative, friend, lawyer, advocate, doctor or anyone else to act on your behalf. You may already have someone authorized by the court or in accordance with State law to act on your behalf.
If you want someone to act for you who is not already authorized by the court or under State law, you and that person must sign and date a statement granting the person legal permission to be your representative. To learn how to name your representative, call Member Services or click here for more information on how to appoint a representative.
Filing a grievance with our plan
The process for making a complaint is different from the process for coverage decisions and appeals. If you have a complaint, you or your representative may call the Member Services phone number listed on the back of your plan ID card. We will try to resolve your complaint over the phone.
If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us.
- Submit a written request for a grievance to:
Attn: Part D Grievances
PO Box 3410
Lisle, IL 60532
- You can call Member Services at (855) 540-4744 (TTY 711).
- You can fax your written request toll-free to (866) 235-1571.
- If you ask for a written response, file a written grievance, or your complaint is related to quality of care, we will respond in writing.
- If you are making a complaint because we denied your request for a "fast coverage decision" or a "fast appeal," we will automatically consider it to be a "fast" complaint. If you have a "fast" complaint, it means we will give you an answer within 24 hours. Please be sure to include the words "fast", "expedited" or "24-hour review" on your request.
Whether you call or write, you should contact Member Services right away. You must make your complaint within sixty (60) calendar days after you had the problem you want to complain about. If possible, we will answer you right away. If your health condition requires us to answer quickly, we will do that. Most complaints are answered within thirty (30) calendar days.
Our response to your complaint will include our reasons for the answer. We must respond whether we agree with the complaint or not.
For more information from Medicare on how to file a complaint, click here to go to Medicare.gov.
To request information for Aggregate Number of Grievances, Appeals and Exceptions to Grievances please call Member Services.