Medicare Advantage (Part C):
Appeals & Grievances

You have the right to file a grievance or submit an appeal and ask us to review your coverage determination.

How to file an Appeal or Grievance

Appeals & Grievances Form

Rights and Responsibilities upon Disenrollment

You have the right to ask us to reconsider this decision. You can ask us to reconsider by filing a grievance with us. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) or click here for more information.

Upon request, Medicare Advantage plans are required to disclose grievance and appeals data to Medicare Advantage enrollees in accordance with the regulatory requirements. You can contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) to request this information.

Appoint a Representative

You can appoint someone to act on your behalf. Go to Medicare.gov to download the Appointment of Representative Form.

Appointment of Representative Form

Prescription Drug (Part D):
Appeals & Grievances

You have the right to file a grievance or submit an appeal and ask us to review your coverage determination.

How to file an Appeal or Grievance

Coverage Determination Form

Coverage Redetermination Form

Rights and Responsibilities upon Disenrollment

You have the right to ask us to reconsider this decision. You can ask us to reconsider by filing a grievance with us. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) or click here for more information.

Upon request, Medicare Advantage plans are required to disclose grievance and appeals data to Medicare Advantage enrollees in accordance with the regulatory requirements. You can contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) to request this information.

FHCP Medicare Appeals & Grievances

Access resources for FHCP Medicare plans.

Visit FHCP Medicare

Send a complaint to Medicare

Go to Medicare.gov to complete and submit a Medicare Electronic Complaint form.

Go to Medicare.gov

FBM GRV 001 NF 052021
Last Updated: 10.01.2020
Y0011_35169