Part C Appeals

Part C Appeals – What is an Appeal?

If we say no to your request for coverage you have the right to ask us to change our mind. To make an appeal means asking for another chance to get the coverage you want.

Making an Appeal

You must make your appeal within 60 days from the date on the letter we sent to you. This letter told you our answer to your request for coverage. If you have a good reason for sending your appeal after the 60 days, we might give you more time.

Appeals Form

How to File an Appeal:

Step 1: To ask for an appeal you have to tell us. The appeal can be from you, your representative, or your doctor.

Step 2: You can write, mail, fax or deliver your appeal, or you can call us.

For a Standard Appeal:

Superior HealthPlan STAR+PLUS MMP
Attn: Appeals and Grievances
7700 Forsyth Blvd.
St. Louis, MO  63105

Phone: 1-866-896-1844, TTY users call 711. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. 

Fax: 1-844-273-2671

If you ask in writing, your appeal must include your:

  • Name.
  • Address.
  • Member number.
  • Reasons for the appeal.
  • Medical records, notes or a letter from your doctor.
  • Other information that shows why you need the item or service. Call your doctor if you need this information.

What Do We Do When You File an Appeal?

We have a different doctor look at your case to see if we should change our mind. We may need more information from you or your doctor. We must make sure we have everything done on time. We will get your appeal done as fast as your health needs, but no later than:

Medical Decisions (Part C & Medicaid) – Standard 30 days
Medical Decisions (Part C & Medicaid) – Fast 72 hours

Prescription Drug (Part D) – Standard 7 days
Prescription Drug (Part D) – Fast 72 hours

For more information, call Member Services at 1-866-896-1844. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711. 

How Do Non-Contracted Providers File a Claim Appeal?  

The Centers for Medicare and Medicaid Services (CMS) says we must offer Medicare appeal rights to non-contracted providers. Medicare appeal rights are for any claim which was denied payment.

  • We must have a completed and signed "Waiver of Liability" (WOL) form.
  • We cannot begin until we get the form.
  • If we do not have the WOL we will send a notice.
  • If we do not have the WOL within 60 days of the explanation of payment (EOP) we will send a notice.
  • We must receive a copy of the EOP and other doctor notes with the appeal request.
  • We will make up our mind within 60 days from the date we received the appeal.

Non-Contracted Provider Appeal Requests should be sent, with the filled out WOL, to:

Superior HealthPlan STAR+PLUS MMP
Grievance and Appeals- Medicare Operations
P.O. Box 4000
Farmington, MO 63640-3822   

Last Updated: 10/01/2016