Important Information

For important information about initial decisions, appeals and grievances, click on one of the links below:

• Medicare Advantage Part C-Requests for Medical Care or Services

• Medicare Advantage Part D-Requests for Prescription Drugs

These documents explain the processes for filing initial determinations, appeals and grievances, including how to request an exception under Part D. Refer to the section titled, "What to do if you have a problem or complaint (coverage
decisions, appeals, complaints)," in the Evidence of Coverage for a complete description of these processes.

To request a coverage determination for Part D Prescription Drugs as described in the second link above, your prescriber will submit a request to National Pharmaceutical Services (NPS), our Pharmacy Benefit Manager. Forms are provided under the "Forms" section of the Prescription Drug Coverage Overview (click here) page.

Remember: to file a grievance related to Part C or Part D, call Member Services or mail a letter to the Complaints and Appeals Department.

Check on the status of a request

You may also check on the status of an initial decision, appeal or grievance, by calling Member Services. 

How to request a report

Request a report on the total number of grievances, appeals, and exceptions filed with the HNE Medicare Advantage Plan by calling Member Services or sending a written request to our Complaints and Appeals Department.

Contact Us

Telephone numbers and our address are listed under the Contact Us link.