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.