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Grievance, Appeals and Organization Determinations

You may also submit feedback or complaints about your Medicare Advantage Health Plan directly to Medicare by submitting a complaint through www.medicare.gov or by calling 1-800-Medicare.

Grievances (Part C and D)
As a Medicare beneficiary, you have the right to file a grievance if you are unhappy or dissatisfied with any of the benefits or services you are receiving including prescriptions.

What is a Grievance?
Medicare indicates that a grievance is any complaint, other than one that involves a request for an initial determination or appeal. You would file a “grievance” for any complaint and/or expression of dissatisfaction from you or your authorized representative regarding services, access to providers, timeliness, treatment, prescriptions, or any other issue you wish to address your dissatisfaction.

How to File a Grievance
As an enrollee of MoreCare, if your complaint is received by telephone, we will address and resolve your complaint by telephone, especially if your complaint involves a possible misunderstanding or misinformation. If you request a written request, or if your concern is regarding a Quality of Care issue, we will respond in writing to you.

The grievance must be submitted within 60 days of the event or incident. We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your complaint. We may extend the time frame by up to 14 days if you ask for the extension or if we justify a need for additional information and the delay is in your best interest.

If you wish to file a grievance with MoreCare, you or your designated representative may call: MoreCare Member Services toll-free at 844-480-8528

Our Member Service office hours are October 1 to March 31, 7 days a week, 8 a.m. to 8 p.m. CST and from April 1 to September 30, Monday – Friday, 8 a.m. to 8 p.m. CST (TTY users call 711).

You may also submit a grievance in written form. Please send it to:

MoreCare
Attn: Grievance and Appeals
P.O. Box 21994
Eagan, MN 55121

Or via Fax: 1-888-345-9110

Other Options: Ask someone to act on your behalf. To name someone as your representative, please download and complete the Appointment of Representative Form, then send it to the Plan.

What is an Appeal?
Appeals for Part C (Medical) Services
Reconsideration is the first level of the appeal process, which involves a Part C plan sponsor reevaluating an adverse organization determination (decision of your Part C medical services), the findings upon which it was based, and any other evidence submitted or obtained.

An Appeal for Medical Services is any of the procedures that deal with the review of adverse organizational determinations that you as the member believe you are entitled to receive. Including delay in providing, arranging for or approving the healthcare services or any amounts you must pay for a service. You can also file an appeal if you believe MoreCare neglected to furnish you with an initial written determination.
Standard appeals must be received verbally or in writing within 60 days from the event or incident.

You may send your written appeal to:

MoreCare
Attn: Appeals Coordinator
P.O. Box 21994
Eagan, MN 55121

Or via Fax: 1-888-345-9110

“Fast” or “Expedited” Appeal
You, your doctor, or your appointed representative may ask us to give a fast appeal (rather than a standard appeal), which is a 72-hour review, by calling MoreCare Member Services toll-free at 844-480-8528, available from April 1 to September 30, Monday – Friday, 8 a.m. to 8 p.m. CST and from October 1 to March 31, 7 days a week, 8 a.m. to 8 p.m. CST (TTY users call 711).

You may also fax it to us at 1-888-345-9110.

Be sure to ask for a “fast,” “expedited,” or “72-hour” review. Remember, if your prescribing doctor provides a written or oral supporting statement explaining that you need the fast appeal process, we will automatically treat you as eligible for a fast appeal.

If you need assistance filing an appeal, you or your designated representative may call MoreCare Member Services toll-free at 844-480-8528, available from April 1 to September 30, Monday – Friday, 8 a.m. to 8 p.m. CST and from October 1 to March 31, 7 days a week, 8 a.m. to 8 p.m. CST (TTY users call 711).

Other Options: Ask someone to act on your behalf. To name someone as your representative, please download and complete the Appointment of Representative Form, then send it to the Plan.

Appointment of Representative Formchevron_right

The form gives that person permission to act on your behalf. It must be signed by you and by the person whom you would like to act on your behalf. You must give us a copy of the signed form and mail or fax back to:

MoreCare
P.O. Box 211025
Eagan, MN 55121

Fax: 1-312-277-9246

For More Information
Members can learn more about coverage determinations, appeals and grievances by reading on this topic in our Evidence of Coverage.

You can also contact the Center or Medicare and Medicaid Services (CMS) at 1-800-Medicare for additional details about the grievance and appeals process. In lieu of calling this number, you can visit the Medicare.gov complaint website.

If you or your provider have questions about the grievance, appeals or exceptions process or would like to obtain an aggregate number of grievance, appeals or exceptions filed under the plan, contact Member Services at 844-480-8528, available from April 1 to September 30, Monday – Friday, 8 a.m. to 8 p.m. CST and from October 1 to March 31, 7 days a week, 8 a.m. to 8 p.m. CST (TTY users call 711). This phone number is also located on the back of your MoreCare ID card.

Click the link below to download the Request for a Reconsideration (appeal form).

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