2021 Coverage Decisions, Appeals & Grievances

 

Requesting an Organization Determination (for Medical Services)

Call: (888) 609-0692 , TTY 711

Fax: (866) 874-0857

Mail:
Harvard Pilgrim Health Care
Medicare Advantage Organization Determination
1600 Crown Colony Drive
Quincy, MA 02169

 

Requesting a Coverage Determination (for a Part D Drug)

Call: (888) 609-0692, TTY 711

Fax: (844) 403-1028

Mail:
OptumRx Prior Authorization Department
P.O Box 25183
Santa Ana, CA 92799

 

Filing an Appeal or Complaint

Call: (888) 609-0692, TTY 711

Fax: (617) 509-4232

Mail
Harvard Pilgrim Health Care
Medicare Advantage Stride
Appeals & Grievances
P.O. Box 690345
Quincy, MA 02269

 

Contacting the Centers for Medicare & Medicaid Services (CMS)

Call: (800) MEDICARE (800-633-4227), TTY (877) 486-2048

Write:
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850

Visit:
www.medicare.gov
Medicare.gov information on filing a complaint
Medicare.gov information on filing an appeal

For more information about appeals and grievances, see your Evidence of Coverage.

You have the right to obtain an aggregate number of grievances, appeals and exceptions that members have filed against our plan in the past. To get this information, ask questions about our process or check the status of an issue, call us at (888) 609-0692, TTY users please call 711.

Links on this page may take you away from the Harvard Pilgrim Health Care website.

Y0098_21111                                                         Last Update: 10/1/20