Medicare Complaints and Appeals

You need to file your complaint within 60 calendar days from the date of the event the grievance occurred. You or someone acting on your behalf (your appointed representative) may submit a complaint.

The easiest way to file an appeal is to call Health Plan Services at 303-602-2111 or toll-free 1-877-956-2111. TTY users should call 711. Or you may choose to complete the  form below.

• Medicare Complaint and Appeal Form

Health Plan Services hours of operation are 8 a.m. to 8 p.m., seven days a week.

How quickly we decide on your complaint depends on the type of grievance:

• For a “fast decision” on a grievance (complaint),” we will give you our answer within 24 hours.  Fast requests must be for medically urgent needs as designated by your provider or our clinical team.
• We will respond to a standard complaint within 30 days.

You need to file your appeal within 65 calendar days from the date included on the notice of our initial coverage decision. We can give you more time if you have a good reason for missing the deadline. You or someone acting on your behalf (your appointed representative) may submit an appeal. If your health requires a quick response, you should ask us to make a "fast decision." 

The easiest way to file an appeal is to call Health Plan Services at 303-602-2111 or toll-free 1-877-956-2111. TTY users should call 711 . Or you may choose to complete one of the  forms below.

• For appeals related to your medical (Part C) coverage: Complaint (Grievance) and Appeal Form.
• For appeals related to your prescription drug (Part D) coverage: Request for Redetermination of Medicare Prescription Drug Denial Form.

Health Plan Services hours of operation are 8 a.m. to 8 p.m., seven days a week.

How quickly we decide on your appeal depends on the type of appeal.

For appeals related to your medical (Part C) benefits:

• For a “fast decision” appeal on a service or benefit, we will give you our answer within 72 hours. Fast appeals must be medically urgent as designated by your provider or our clinical staff.
• We will respond to a standard appeal (services have not been received) within 30 days of receiving your appeal.
• We will respond to a post service appeal (services have been received) within 60 days of receiving your appeal.

For appeals related to your prescription drug (Part D) benefits:

• For a “fast decision” appeal  for a medication,  we will give you our answer within 72 hours.
• We will respond to a standard appeal for prescription drugs within 7 days of receiving your appeal.
• We will respond to an appeal for payment within 14 days of receiving your appeal.

We must gather all the information we need to make a decision about your appeal. If we need your help in getting this information, we will contact you.

If your request is denied in whole or in part after our appeal review, we will forward your appeal to a Medicare Independent Reviewer who will notify you of their decision.  

An authorized representative is the person you choose to help with your health care services. This can be a family member, friend, caregiver, or doctor. Your authorized representative can help you with an appeal or complaint.

How do I appoint a representative?

You may appoint someone else to act as your representative by filling out the Appointment of Representative Form. Both you and your representative must sign the form. Fax the completed form to the number below.

By Fax:
303-602-2078
 

If you would like more information about our appeals, complaints and exceptions, please contact the Complaints (Grievances) and Appeals Department at 303-602-2261.

You are able to submit feedback or complaints about your Medicare health plan or prescription drug plan directly to the CMS 24-hour helpline by calling 1-800-MEDICARE or by submitting a complaint using the Medicare Complaint form on the Medicare website. For more information, visit www.medicare.gov.