- Requesting a Part D (Pharmacy) Request for Coverage Determination Exception, Appeal, or Grievance
- Requesting a Part C (Medical) Request for Organization Determination, Appeal or Grievance
Requesting an Organization Determination (for Medical Services)
Call: (888) 609-0692 , TTY 711
Fax: (866) 874-0857
Mail:
Harvard Pilgrim Health Care
Attention: Stride Utilization Management
1 Wellness Way
Canton, MA 02021
Requesting a Coverage Determination (for a Part D Drug)
Call: (888) 609-0692, TTY 711
Fax: 1-671-673-0956
Mail:
Harvard Pilgrim Health Care
Attention: Pharmacy Utilization Management
1 Wellness Way
Canton, MA 02021
Filing an Appeal or Complaint
Call: (888) 609-0692, TTY 711
Fax: (617) 509-4232
Mail
Harvard Pilgrim Health Care
Attention: Medicare Advantage Appeals & Grievances
PO BOX 328
Canton, MA 02021
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.
H6750_23036 Last Update: 10/01/2022