Part D Redetermination / Appeal Process

An appeal to the plan about a Part D Drug Coverage Decision we made is called a Redetermination (Appeal).

Use this process to ask us to review a Part D drug Coverage Decision made by us.

Note: You cannot request a Part D Redetermination (Appeal) if we have not issued a Coverage Determination.

What to do

• To start your Part D Redetermination (Appeal), you (or your representative or your doctor or other prescriber) must contact our plan:
  • If you are asking for a standard appeal, make your appeal by mailing a written request to:
    
    SCAN Health Plan Arizona
    Attention: Grievances and Appeals Department
    1313 E. Osborn Rd., Suite 150
    Phoenix, AZ 85014
  • If you are asking for a fast appeal, you may make your appeal in writing or you may call our Member Services Department at:
    
    1-888-540-7226, 7:00 a.m. – 8:00 p.m, 7 days a week
    
    TTY users: 711, 7:00 a.m. – 8:00 p.m, 7 days a week
  • You may also Fax your request to: 1-602-778-3341.
• When making your written request be sure to include the following information:
  • Member Name
  • Member ID number - This can be found on your SCAN membership card
  • Name of the Part D drug that you are asking us to review
  • Reason you do not agree with the initial Coverage Determination
  • Date of initial Coverage Determination notice
• To find out more details about the Part D Redetermination process refer to your Evidence of Coverage booklet, Chapter 9, Section 6.5 How to ask for a coverage decision or make an appeal. Or call our Member Services at the number(s) listed above.