LEVEL I APPEAL

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How to ask for a review of a coverage decision on a Part D Medicare covered drug made by our plan.

  • You, your authorized representative, doctor or other prescriber must contact our plan.
  • Make your appeal in writing by submitting a signed request To make your request in writing, by fax or by E-mail contact:

    Florida Health Care Plans
    Attn; Member Services
    1340 Ridgewood Avenue
    Holly Hill, FL 32117
    Fax#: 386-676-7149
    E-mail: Member Services click here

  • You must make your appeal request within 60 days from the date on the written notice we sent you to tell you our answer to your request for a coverage decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal.
  • You can ask for a copy of the information in your appeal and add more information.
    • You have the right to ask us for a copy of the information regarding you appeal. We are allowed to charge a fee for copying and sending this information to you.
    • If you wish, you and your doctor or other prescriber may give us additional information to support your appeal.

If your health requires it, ask for a "fast appeal"

Our plan considers your appeal and we give you our answer.
Deadlines for a "fast" appeal.

  • We must give you our answer within 72 hours after we receive your appeal.
  • If we do not give you an answer within 72 hours, we are required to send your request on to Level 2 of the appeal process, where it will be reviewed by an Independent Review Organization.
  • If our answer is yes to part or all of what you requested we must provide the coverage we have agreed to provide within 72 hours.
  • If our answer is no we will send you a written statement that explains why we said no and how to appeal our decision.
Deadlines for a "Standard" appeal.
  • We must give you our answer within 7 calendar days after we receive your appeal.
  • If we do not give you an answer within 7 calendar days, we are required to send your request on to Level 2 of the appeal process, where it will be reviewed by an Independent Review Organization.
  • If our answer is yes to part or all of what you requested we must provide the coverage we have agreed to provide within 7 calendar days.
  • If our answer is no we will send you a written statement that explains why we said no and how to appeal our decision.
Level 2 Appeal
To make a Level 2 Appeal you must contact the Independent Review Organization and ask for a review of your case.

For more information on the Part D drug appeals process including additional Level 2 and any additional Levels of appeal please see the following:
  • Members of the Medvantage Rx Plan please refer to Chapter 9 of your Evidence of Coverage for complete information on filing a grievance.
  • Members of the Medvantage Rx Plus Plan please refer to Chapter 9 your Evidence of Coverage for complete information on filing a grievance.