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Coverage Decisions, Appeals and Grievances

Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage)

To file or check the status of a grievance or an appeal‚ contact us at:

  • Grievances: (800) 965-4022 (877) 750-3350 (877) 917-8550, 8 a.m. to 8 p.m., Monday through Friday
  • Appeals: (800) 965-4022, 8 a.m. to 8 p.m., Monday through Friday
  • Appeals: (877) 750-3350, 8 a.m. to 8 p.m., Monday through Friday
  • Appeals: (877) 795-6117, 8 a.m. to 8 p.m., Monday through Friday
  • Fax: (217) 902-9708
  • Mail:
    Health Alliance Medicare
    Attn: Member Relations
    3310 Fields South Dr.
    Champaign, IL 61822
  • Mail:
    Health Alliance Medicare
    Attn: Member Services
    411 N. Chelan Ave.
    Wenatchee, WA 98801

Where can I find an appeal form?

There are no specific appeal forms. If you need to register an urgent appeal and it’s after business hours, you can leave a message at (800) 500-3373, and we’ll call you the next business day.

If a member wants someone who is not already authorized under state law to act for him or her, the member and that person must sign and date an Appointment of Representative form to give that person legal permission to be an appointed representative.

You or your appointed representative can file a redetermination (appeal) by faxing (217) 902-9708 or emailing:

The fax or email should contain the following information:

  • Member's name, date of birth and member ID number
  • Service or medication being appealed
  • Date of service if applicable
  • Name of provider
  • What took place or information about the situation
  • Why it happened if applicable

How do I file a grievance?

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, (800) 368-1019, TTY: (800) 537-7697. Complaint forms are available at

For more on this process, see “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Evidence of Coverage.

What if I don’t want to file my complaint through the health plan?

You can also go directly through or call 1 (800) MEDICARE to file a complaint.

You can also get help with Medicare-related complaints, grievances, and information requests from Medicare's Ombudsman.

How do I request a coverage determination or medical exception for a drug?

You, your authorized representative, or your prescribing doctor can use our Coverage Determination Request Form to ask for a coverage determination. Send any additional chart notes in one of the following ways:

You can also file an urgent request by calling us.

How do I get an aggregate number of grievances, appeals, and exceptions?

You have the right to get information about the number of appeals, grievances, and exceptions that members have filed against us in the past. To get this information, call us.