Part D Appeals
Part D 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 prescription drug 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.
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
7000 Forsyth Blvd.
St. Louis, MO 63105
Phone: 1-866-896-1844, TTY call 711
If you ask in writing, your appeal must include your:
- 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 it, but no later than:
Prescription Drug (Part D) – Standard: 7 days
Prescription Drug (Part D) – Expedited: 72 hours
What Happens Next?
If we do not agree with your appeal, we will send you a letter. We will also send your case to an independent reviewer. An independent reviewer is a third-party reviewer called the Medicare Independent Review Entity or IRE. The IRE will send you a letter with a decision and tell you if you have more options.
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.
Last Updated: 10/01/2016