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Medicare Complaints, Grievances, and Appeals

This is a summary of the process and contact information for Coverage Decisions, Complaints, Appeals & Grievances with Virginia Premier. Many issues or concerns can be promptly resolved by calling Member Services at 1-877-739-1370 (TTY: 711).From October 1 to March 31, we are open daily from 8:00 am to 8:00 pm, 7 days a week. From April 1 through September 30, we are open Monday through Friday, 8:00 am to 8:00 pm. On certain holidays and weekends from April 1 through September 30, your call will be handled by our automated phone system. 

If you have not already done so, you may want to first contact Member Services before submitting one of the forms below. Complete information about Coverage Decisions, Complaints, Appeals and Grievances can be found in your plan’s Evidence of Coverage.

Appeals Submission Tool

Because we, Virginia Premier, denied your request for coverage of (or payment for) a particular service, you have the right to ask us for an appeal of our decision. You have 60 days from the date of our Integrated Denial Notice or Denial of Medicare Prescription Drug Coverage to ask us for an appeal.

Who May Make a Request: You or your provider may ask us for an appeal on your behalf. If you want another individual, such as a family member or friend, to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.

Note: All fields marked with an asterisk (*) are required.

  • Date Format: MM slash DD slash YYYY
  • Complete the following section ONLY if the person making this request IS NOT the member or provider:

  • Representation documentation for requests made by someone other than member or the member’s provider:

  • Attach documentation showing the authority to represent the member (a completed Authorization of Representation Form CMS-1696 or a written equivalent). For more information on appointing a representative, contact your plan or 1-800-Medicare.

    Authorization of Representation Form CMS-1696

  • Accepted file types: doc, docx, pdf.
  • Prescription drug or service you are requesting:

  • Provider's Information

  • Important Note: Expedited Decisions

  • If you or your prescriber believe that waiting 7 days for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 7 days could seriously harm your health, we will automatically give you a decision within 72 hours. If you do not obtain your prescriber's support for an expedited appeal, we will decide if your case requires a fast decision. You cannot request an expedited appeal if you are asking us to pay you back for a drug you already received.

    For Part D please allow

    • 72 hours — expedited (fast) requests
    • 7 calendar days — standard requests

    For Part C please allow

  • 72 hours — expedited (fast) requests
  • 30 calendar days — standard requests or 60 calendar days — standard payment requests.

Expedited appeal requests can be made by phone at 1-877-739-1370

  • Accepted file types: doc, docx, pdf.
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