Coverage Decisions, Appeals, and Grievances

Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage)

To file or check the status of a grievance or an appeal‚ contact us at:

  • Grievances: Illinois, Indiana, and Ohio: 1-800-965-4022 Washington: 1-877-750-3350 Iowa: 1-877-917-8550, 8 a.m. to 8 p.m., Monday through Friday, TTY/TDD 711
  • Appeals: 1-800-500-3373, 8 a.m. to 8 p.m., Monday through Friday
  • Fax: Illinois, Indiana, Iowa, and Ohio: 217-337-3425 Washington: 509-662-0735
  • Mail:
    Health Alliance Medicare
    Services Appeals Processing Center
    301 S. Vine St.
    Urbana, IL 61801

You can file a coverage determination right away by emailing: *TEAM-RXCOORDINATORS@healthalliance.org

You can file a redetermination (appeal) right away by emailing: MemberServices@healthalliance.org

Where can I find an appeal form?

There are no specific appeal forms. If you need to register an urgent appeal and it’s after business hours, you can leave a message at our appeals phone number at 1-800-500-3373, and we’ll call you back the same day.

If a member wants someone who is not already authorized under state law to act for him or her, the member and that person must sign and date an Appointment of Representative form to give that person legal permission to be an appointed representative.

How do I file a grievance?

You or your appointed representative can call the grievances phone number to file a grievance.

For more on this process, see “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Evidence of Coverage.

What if I don’t want to file my complaint through Health Alliance Medicare?

You can also go directly through Medicare.gov or call 1-800-MEDICARE to file a complaint.

You can also get help with Medicare-related complaints, grievances, and information requests from Medicare's Ombudsman.

How do I request a coverage determination or medical exception for a drug?

You, your authorized representative, or your prescribing doctor can use our Coverage Determination Request form to ask for a coverage determination. You can also file an urgent request by calling us.

How do I get an aggregate number of grievances, appeals, and exceptions?

You have the right to get information about the number of appeals, grievances, and exceptions that members have filed against us in the past. To get this information, call us.