Medicare Prescription Payment Plan Appeals & Grievances

Your satisfaction with participating in the Medicare Prescription Payment Plan is important to us. If you have a problem or concern, please contact us and we will work with you to try to find a solution to your problem. If we are not able to help find a solution, you may file a complaint or dispute, also called a grievance or appeal.

What is a grievance?

A grievance is a type of complaint or dispute you make to us about any part of the Medicare Prescription Payment Plan including election requests, billing requirements, and termination related issues.

Your grievance must be made within 60 days after you had the problem you want to make a complaint about. We will respond to your complaint within 30 days after receiving your request but may take up to 44 days.

How to submit a grievance?

You may file a grievance with our Plan either by phone or in writing. To contact us by phone, please call Blue Advantage Member Services at 1-888-234-8266 8 a.m.. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays, you may be required to leave a message. Calls will be returned the next business day. TTY users should call 711. To contact us in writing, please submit your signed grievance to:

Blue Cross and Blue Shield of Alabama
Attention: Grievances
P.O. Box 995
Birmingham, AL 35298

You may also submit feedback about your Medicare health plan or prescription drug plan directly by visiting
https://www.medicare.gov/MedicareComplaintForm/home.aspx, in lieu of calling 1-800-Medicare. 

What if I want to dispute the amount I'm being billed in the program?

You may make an appeal if you disagree with the amount you are responsible to pay for a prescription drug you received.

An appeal is the type of complaint or dispute you would file if you disagree with the amount you are responsible to pay for a prescription drug you have already received.

You start the appeals process by contacting our Plan. You must first contact our plan by submitting a signed request. Your appeal request must be done within 60 calendar days from the date on the bill or written you received. If we determine the amount on the bill or written notice is correct, but you still feel like there is an error, you must then decide to continue with the appeals process and make another appeal.

There are two kinds of Part D appeals:

• Standard appeal. For payment appeals, we must respond to your request within 60 calendar days after we receive your appeal. You must make your appeal request within 60 calendar days from the date on the bill or written notice we sent.
• Expedited appeal. If your situation requires a quick response, you can ask for an expedited appeal. We must respond to your request within 72 hours after we have received your appeal.

How to submit an appeal?

You may file an appeal by submitting a signed request within 60 calendar days from the date on the bill or written notice received. Please submit your signed appeal to:

Medicare Part D Appeals Department
2900 Ames Crossing Road
Eagan, Minnesota 55121

Or you can fax your written appeal request to 1-800-693-6703.

How to appoint a representative?

An enrollee may appoint any individual (such as a relative, friend, advocate, attorney, physician, or an employee of a pharmacy, charity, state pharmaceutical assistance program, or other secondary payor) to act as his or her representative. A representative who is appointed by the court or who is acting in accordance with State law may also file a request for a coverage determination or appeal on behalf of an enrollee. The enrollee making the appointment and the representative accepting the appointment must sign, date, and complete an Appointment of Representative form (CMS-1696 Form).