Medicare Health Plans

Medicare Appeals & Grievances

If you would like to request a determination or redetermination by phone call us at 1-800-521-0265 or TTY 1-800-743-3333, 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.

PDF Download Complaints about Rx Coverage

Please click on the link above for more information.

PDF Download 2011 How to File a Grievance

The formal name for “making a complaint” is “filing a grievance.” Please click on the link above for more information

PDF Download 2011 How to File an Appeal

An appeal is something you do if you disagree with a decision to deny a request for health care services or prescription drugs or payment for services or drugs you already received. Please click on the link above for more information.

PDF Download Appeal & Grievance Form

PDF Download Appoint A Representative

Please complete and return the above form to appoint an individual to act on your behalf.

PDF Download2011 Evidence of Coverage (EOC) - WHP Silver (HMO)

PDF Download2011 Evidence of Coverage (EOC) - WHP Silver Rx (HMO)

PDF Download2011 Evidence of Coverage (EOC) - WHP Platinum Rx (HMO)

PDF Download2011 Evidence of Coverage (EOC) - Platinum Select Rx (HMO-POS

Updated 01/11

H3044_H1558_WEB11_CMS_Approved_10012010

Welborn Health Plans
Welborn Health Plans

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