Appeals, Complaints and Coverage Decisions
Medicare uses a lot of formal terms when it comes to appeals, complaints and coverage decisions. If you have a complaint, you file a grievance. If your doctor wants you to have a medical service or prescription drug and you're not sure if your plan will cover it, you can ask us to make a coverage decision. And if you disagree with our decision, you appeal.
Fortunately, contacting us is simpler than the terminology. If you have a Medicare Advantage or a Prescription BlueSM PDP plan, for all these things you can start by calling the customer service number on the back of your Blues ID card. Learn more about appeals, complaints and coverage decisions in our frequently asked questions below.
Frequently asked questions
- How do I appeal a decision you made about my coverage?
If you don't agree with a decision we made about what your plan covers or how it covers it, you can appeal. Learn more here. - What if I have a complaint?
Find out how to contact us when you experience problems with quality of care, customer service and other issues not related to your plan benefits or coverage. - What do I need to know about coverage decisions?
What if your plan doesn't cover a medical treatment or test? Your doctor can ask us to cover it by requesting a coverage decision.
Forms and documents
- Prescription drug coverage determination forms
You can use these forms to ask us to cover medications that aren't on drug plan lists. - Appointment of Representative Form
Michigan Medicare members can use this form to choose a representative for their medical decisions. Download it here.
