Grievances, Redeterminations & Appeals

Grievance

  • A grievance is an expression of dissatisfaction (other than a coverage determination) with any aspect of the operations, activities, or behavior of a Part D plan sponsor, regardless of whether remedial action is requested.
  • Examples of grievances include:
    • Problems with customer service;
    • If an enrollee disagrees with a plan sponsor’s decision not to expedite a request for a coverage determination or redetermination; or
    • If an enrollee believes the plan sponsor’s notices and other written materials are difficult to understand.

Filing Procedures

  • Grievances can be completed in verbal or written form and must be completed no later than 60 days after the incident that precipitates the grievance.
  • Phone number for receiving oral requests: 1-888-217-2376
  • Fax number for written requests: 1-214-321-1893
  • Mailing address for written request:
    Exemplar Health
    1107 West Market Center Drive
    High Point, NC 27260

Redeterminations

You may use our online form here.

Appeals

Last Updated on September 14, 2020 by marketing