When to File a Grievance or Appeal
Use an Appeal to Ask for Redetermination
If you have received an unfavorable coverage determination, you can ask for an appeal by the following the instructions given in the determination notice or as outlined below:
More information is available here:
How to Appeal Guide:
Or you may request a Part D appeal for
Use a Grievance to File a Complaint
If you are dissatisfied with any aspect of the operations, activities, or behavior of CarePlus or its providers, you can submit a grievance at any time by following the instructions below.
How to File a Grievance:
You may submit feedback directly to the Centers for Medicare & Medicaid Services. You may fill out the
How to File a Grievance or Appeal
To file a grievance or appeal, you can contact CarePlus by phone, fax, or mail.
By phone
Call CarePlus
Fax or mail
Download a copy of the Grievance or Appeal Request Form and fax or mail it to CarePlus:
Grievance or Appeal Request Form:
Fax: 1-800-956-4288
Mailing address:
CarePlus Health Plans
Attention: Grievance and Appeals Department
P.O. Box 277810
Miramar, FL 33027
Request for Redetermination of Medicare Prescription Drug Denial
To request a
Request for Redetermination of Medicare Prescription Drug Denial Request Online Form in
Request for Redetermination of Medicare Prescription Drug Denial Form in
Who can Submit a Grievance or Appeal?
As a CarePlus member, you or a person you appoint can file a grievance with CarePlus. You, a person you appoint, your physician, or your prescribing doctor can submit an appeal request. More information about appointing a representative is available
Waiver of Liability
If an out-of-network doctor files an appeal for a denied claim, he or she must include a completed a Waiver of Liability Form with the appeal request The Waiver of Liability states that the non-contracted (out-of-network) healthcare provider will not bill you, regardless of the outcome of the appeal.
