Member Resources

Medicare Appeals and Grievances

Effective April 1, 2018, Premier Health Plan no longer offers any Medicare Advantage products.

If you have any questions or concerns about appeals and grievances, when you were a Premier Health Plan Medicare Advantage member, you can call Premier Health Plan's Member Services Department, (855) 572-2161(855) 572-2161. TTY users should call (855) 250-5604(855) 250-5604. Representatives are available to assist you live from October 1 through February 14, seven days a week from 8:00 am to 8:00 pm. From February 15 through September 30, representatives are available to assist you live on Monday through Friday from 8:00 am to 8:00 pm and Saturday from 8:00 am to 3:00 pm. If you call on a Federal holiday from February 15 to September 30 or outside of the date and time windows listed above, you may leave a voicemail message and your call will be returned within one business day.

What is an Appeal?

An appeal is a request made by you or your representative to reconsider a decision that has been made regarding a medical service or the amount your insurance company will cover for that healthcare service, supply, item or prescription drug.

2018 Plan Year

Organization Determinations

When a coverage decision involves your medical care, it is called an organization determination. To request for a coverage decision on medical care or service you want but have not received please call our Member Services Department at (855) 572-2161(855) 572-2161. TTY users should call (855) 250-5604(855) 250-5604 for assistance. Representatives are available to assist you live from October 1 through February 14, seven days a week from 8:00 am to 8:00 pm. From February 15 through September 30, representatives are available to assist you live on Monday through Friday from 8:00 am to 8:00 pm and Saturday from 8:00 am to 3:00 pm. If you call on a Federal holiday from February 15 to September 30 or outside of the date and time windows listed above, you may leave a voicemail message and your call will be returned within one business day.

Were you a Premier Health Plan HealthOne member?

If you were a Premier Health Plan HealthOne member and you have questions about the contact information for a provider or a pharmacy from which you obtained covered services before April 1, 2018, you may call Premier Health Plan's Member Services at (855) 572-2159(855) 250-572-2159 for assistance.

2018 Plan Year


Disclaimers

Learn more about Premier Health Plan's nondiscrimination notice.

H3233_18_4039 Pending CMS Approval
Last Updated: 1/1/2018