Medicare Drug Grievances and Appeals

A senior Asian man ris putting his medication in a pill case.

Prescription Drug Grievances and Appeals Information

If you requested a coverage determination and your request was not approved, you may appeal this decision. Below, you’ll find all the information you need to appeal.

Prescription Drug Appeals and Grievances

If you requested a coverage determination and your request was not approved, you may appeal this decision by using this form:

Redetermination (Appeals) About Part D Prescription Drugs

Fill out the form and send it to us as a standard or expedited appeal within 60 calendar days from the date of the notice of the coverage determination (except when the filing time frame is extended). You need to include the following information with your written appeal:

First name, last name, address, phone number, date of birth, and ConnectiCare ID number

The name of the prescription drug you want us to cover

Reason why you are appealing

Your signature, or if someone is acting on your behalf, a completed appointment of representative form CMS-1696 or a written equivalent (if it was not submitted with the coverage determination)

You should send supporting documentation, including medical records, with your appeal request.

You, your appointed representative or your prescribing physician may request ConnectiCare expedite a coverage determination when you or your physician believes that waiting for a decision under the standard time frame may place your life, health, or ability to regain maximum function in serious jeopardy. A claim for payment for prescription drugs that you have already received will not be expedited.

You can submit your Expedited Redetermination Appeal request to us in one of the following ways:

CALL 800-224-2273 (TTY: 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Saturday from 8 a.m. to 8 p.m.
FAX - 800-867-6674
WRITE -
- ConnectiCare
  Part D Expedited Grievances and Appeals
  P.O. Box 4010
  Farmington, CT 06034
  Attention: Medicare Appeals Department

Email - PartDExpeditedAppeals@Connecticare.com

You can submit your Standard Redetermination Appeal request to us in one of the following ways:

CALL - 800-224-2273 (TTY: 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Saturday from 8 a.m. to 8 p.m.
FAX - 800-867-6674
WRITE -
- ConnectiCare
  Part D Grievances and Appeals
  P.O. Box 4010
  Farmington, CT 06034
  Attention: Medicare Appeals Department
Email - PartDStandardAppeals@ConnectiCare.com

Understanding Grievances (Complaints) for Part D Prescription Drugs

You have the right to file a grievance (complaint) with us if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for the state of Connecticut. Please refer to the Evidence of Coverage (EOC) for the Beneficiary and Family Centered Care Quality Improvement Organization (Also known as BFCC-QIO) contact information.

Make sure to include the following information in your grievance:

First name, last name, address, phone number, date of birth, and ConnectiCare ID number

Reason why you are filing a grievance

Your signature, or if someone is acting on your behalf, a completed Appointment of representative form CMS-1696 or a written equivalent

You should send any supporting documentation, including medical records, with your grievance.

You can submit your grievance to us in one of the following ways:

CALL - 800-224-2273 (TTY : 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Saturday from 8 a.m. to 8 p.m.
FAX - 800-867-6674
WRITE
- ConnectiCare
  Part D Grievances and Appeals
  P.O. Box 4010
  Farmington, CT 06034
  Attention: Medicare Appeals Department

How can I obtain information about an aggregate number of grievances, appeals, and exceptions filed with ConnectiCare?

If you want information about the aggregate number of grievances, appeals, and exceptions filed with ConnectiCare, you may contact member services at 800-224-2273 (TTY: 711). From Oct. 1 to March 31, you can call from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call from 8 a.m. to 8 p.m., Monday through Friday to request a report, check status, or process questions.

You can submit a complaint directly to Medicare. To submit an online complaint to Medicare, go to Medicare Complaint Form.

MY COVERAGE

Drugs Covered by Medicare Advantage Plans

Find the list of drugs covered by your ConnectiCare plan (also known as a “formulary”) below.

View FormulariesView Formularies

YOUR MEDICATION

Medicare Advantage Delivery and Refills

Find out how to set up home delivery or a get a prescription refill.

Get MedicationsGet Medications

Female pharmacist smiling and putting hand on customer's shoulder.

MTM PROGRAM

Medication Therapy Management

Find out if you qualify for this service program which is provided at no additional cost for eligible ConnectiCare Medicare Advantage plan members who have Part D prescription drug coverage.

Learn MoreLearn More