Medicare complaints, exceptions and grievances
The instructions here are for members of Priority Health Medicare Advantage and Prescription Drug Plans.
The Medicare program has rules about what members of Priority Health Medicare plans need to do to ask for exceptions or make complaints about their coverage or their service, and how we must handle their requests and complaints.
- We must be fair in how we handle it.
- You can't be disenrolled from a Priority Health Medicare plan or penalized in any way.
Step one: Call us!
Whatever you need, call Customer Service right away. We might be able to resolve your question or concern or approve your request over the phone.
Step two:
| Ask for a "coverage decision" about your benefits | Or, file a complaint about service |
|---|
| Formally request an exception or otherwise ask us to pay for a drug or medical service that you believe should be covered by your plan, and how to appeal if our decision is not in your favor. Go to coverage decision instructions. |
Make a complaint about the service you receive from us or from our network of doctors, hospitals, pharmacies and other health care providers. Go to service complaint instructions. |
Naming someone to help you
If you want someone else, like a spouse, child or friend, to act for you when you make a complaint or appeal a decision, you can sign a form that makes that person your official "authorized representative." Here's how:
- Print our Appointment of Representative form. (120KB PDF)
OR Medicare's appointment of representative form (120KB PDF) - Write in the name of the person you want to act for you. Sign and date the form.
- Have your representative sign and date the form.
- Mail the form to us at:
Priority Health Medicare Coordinator
1231 East Beltline NE, MS 1115
Grand Rapids, MI 49525
You can also deliver it in person at these locations, or fax it to us at 616 975-8826, or call Customer Service.
More details about filing exception requests and complaints
To better understand the services you are entitled to under your Priority Health Medicare plan, including more details about asking for coverage exceptions and filing a complaint, you can refer to the "Evidence of Coverage" booklet for your plan.
