Need to file a Grievance or Appeal?
Use the forms and guidance on this page for grievances and appeals including redetermination and waiver of liability.

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: English | Spanish

Or you may request a Part D appeal for Prescription Drug Coverage Redetermination

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: EnglishSpanish

You may submit feedback directly to the Centers for Medicare & Medicaid Services. You may fill out the Medicare Complaint form with the information and concern. 

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 Member Services

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: English | Spanish

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 Prescription Drug (Part D) appeal (redetermination), download the Request for Redetermination of Medicare Prescription Drug Denial Forms below or submit your request using the following online form:  

Request for Redetermination of Medicare Prescription Drug Denial Request Online Form in English or Spanish  

Request for Redetermination of Medicare Prescription Drug Denial Form in English or Spanish

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 here

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. 

Waiver of Liability Form