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Can I appeal my Medicare Prescription Drug Plan's decisions?
Yes. You have the right to get a written explanation from your Medicare Prescription Drug Plan if your request for a drug is denied. Some reasons you might ask for a written explanation are if the pharmacist tells you that your drug plan won't cover a prescription or you are asked to pay more than you think you are required to pay. You also have the right to ask your drug plan for an Exception if you and your doctor believe you need a drug that isn't on your drug plan's list of covered drugs.
If you disagree with the information provided by a pharmacist, you can contact your plan to ask for a Coverage Determination (Part D). The pharmacy will give or show you a notice that explains how to contact your Medicare drug plan.
If your plan doesn't respond to your request for a drug, an appeal, or an exception, you can file a grievance with the plan sponsor, or file a complaint by calling 1-800-MEDICARE (1-800-633-4227), or both. TTY users should call 1-877-486-2048.
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A standard request must be made in writing unless your plan accepts requests by phone. You or your doctor can call or write your plan for an expedited (fast) request. Once your Medicare drug plan gets your request for a Coverage Determination (Part D), the Medicare drug plan has 72 hours (for a standard request) or 24 hours (for an expedited request) to notify you of its decision. If you are requesting an Exception , your prescribing doctor must provide a statement explaining the medical reason why your request should be approved. Your plan generally has 72 hours (for a standard request) or 24 hours (for an expedited request) to notify you of its decision once your plan receives your doctor's statement.
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If you disagree with your Medicare drug plan's decision, you have the right to appeal. You must request the appeal within 60 calendar days from the date of the decision. A standard request must be made in writing unless your Medicare drug plan accepts requests by phone. You can call or write your plan for an expedited request. Once your Medicare drug plan receives your request for an appeal, the Medicare drug plan has seven days (for a standard request for coverage) or 72 hours (for an expedited request for coverage) to notify you of its decision.
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(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook 2007. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)
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Last updated on: 07/05/2009
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Life Insurance plays an important role in your families financial stability.
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