REQUEST FOR REDETERMINATION (APPEAL) Part D
Because we at Health Net® Medicare Programs denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination. Expedited appeal requests can be made by phone.
Cal MediConnect members in Los Angeles county call 1-855-464-3571
Cal MediConnect member in San Diego county call 1-855-464-3572
- Can I Expedite My Request?
If you or your prescriber believe that waiting 7 days for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 7 days could seriously harm your health, we will automatically give you a decision within 72 hours. If you do not obtain your prescriber's support for an expedited appeal, we will decide if your case requires a fast decision. You cannot request an expedited appeal if you are asking us to pay you back for a drug you already received. Please note that Claims Appeals will not be accepted for expedited Appeal/Redetermination.