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., weekdays, 8 a.m. to 8 p.m.
- Appeals: (800) 500-3373, 8 a.m. to 8 p.m., Monday through Friday
- Fax: (217) 902-9798 (509) 662-0735
Health Alliance Medicare
Attn: Member Relations
3310 Fields South Dr.
Champaign, IL 61822Health Alliance Medicare
411 N. Chelan Ave. Suite A
Wenatchee, WA 98801Health Alliance Medicare
1701 Creekside Loop #100, Building 11
Yakima, WA 98902
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) 902-9798 or emailing: Member.Relations@healthalliance.org
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 or your appointed representative can call the grievances phone number to file a grievance.
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 Medicare.gov 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:
- Fax: (217) 902-9798
Health Alliance Medicare
Attn: Pharmacy Department
3310 Field South Dr.
Champaign, IL 61822
- Email: TEAM-RXCOORDINATORS@healthalliance.org
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.