Medicare Health Plans

Appeals and Grievances

If you would like to request a determination or redetermination by phone call us at 1-800-521-0265 TTY 711, 7 days/wk, 8 a.m. to 8 p.m.

You may also write to us at 101 S. E. Third Street Evansville, IN 47708 or FAX to the Medicare Department at 716-541-6365.

The formal name for “making a complaint” is “filing a grievance. An appeal is something you do if you disagree with a decision to deny a request for healthcare services or prescription drugs or payment for services or drugs you already received.

Select a topic in blue below to view more information

Complaints About Rx Coverage
2012 How to file a grievance
2012 How to file an appeal
2012 appeal and grievance form
2012 Appoint a representative form

To view the 2012 Evidence of Coverage (EOC) Please click on your plan name below.
Silver (HMO)
Value Rx (HMO)
Silver Rx (HMO)
Platinum Rx (HMO)
Platinum Select Rx (HMO-POS)

 

Updated 03/2012

H3044_WEB12_CMS_APPROVED_10112011

 

Welborn Health Plans
Welborn Health Plans

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