Grievance and Appeals

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Current and Prospective Members
Current and Prospective members please call (866) 321-3947 for questions related to the America's 1st Choice Health Plans: 7 days - 8AM to 8PM EST from Nov 15th – Mar 1st Mon – Fri 8AM to 8PM EST from Mar 2nd – Nov 14th (TTY/TDD) - (800)735-8583 For questions related to your Medicare Part D Prescription Drug program please call (866)321-3947)

Medicare
For more information about Medicare, please call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, visit www.medicare.gov on the web.

Service Area
Review the counties America's 1st Choice participates in. You must live in one of these counties to join the plan. :: Service Areas

Our Grievance and Appeal Process
First, ask yourself if you want to make a Grievance or an Appeal?

An Appeal is a complaint you make if you disagree with a coverage or payment decision. You can appeal if you request a health care service, supply, or prescription that you think you should be able to get, or if you request payment for health care you already got, and Medicare or your plan denies the request.
A Grievance is a complaint about the way your Medicare health plan is giving care. For example, you may file a grievance if you have a problem calling the plan or if you are unhappy with the way a staff person at the plan has behaved toward you.

Second, ask yourself if this is a Part D (Prescription Drug) Grievance, Appeal, or Coverage Determination?

An Part D Appeal is any of the procedures that deal with the review of an unfavorable coverage determination or exception request.
A Part D Grievance is any other type complaint regarding Part D benefits or services.
A Part D Coverage Determination is the first decision (made by America's 1st Choice not the pharmacy) about your drug benefits, including whether to provide or pay for a drug or to grant an exception request.

To learn more about our Grievance and Appeal Process or to learn how to make an Appeal, Grievance, or Coverage Determination, read more.

Coverage Determination/Tier Exception Request- Member

Coverage Determination Request- Provider

For Member Grievance form, click here

Last Updated 06/14/2010
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America´s 1st Choice is a health Plan with a Medicare contract. Medicare approved Medicare Advantage Private Fee for Service plans available to anyone entitled to Part A and enrolled in Part B of Medicare through age or disability, not in ESRD, and in an approved service area. Enrollment period restrictions apply. Call the plan for details. You must continue to pay your Medicare applicable premiums if not otherwise paid for under Medicaid or by another third-party. Plans may be renewed annually. All plan types may not be available in all areas. Benefits vary by plan and counties.
H9720_Web_CMS__2010 CMS approval 1/15/10	© 2007 America's 1st Choice Health Plans, Inc. All Rights Reserved.