How to get help with your Medicare coverage and service issues

The Medicare program has set rules about what members of Priority Health Medicare plans need to do to make a complaint about their coverage or their service, and how we must handle your complaint.

• If you make a complaint, we must be fair in how we handle it.
• You can't be disenrolled from a Priority Health Medicare plan or penalized in any way if you make a complaint.

Step one: Call us!

If you have questions, concerns or problems with your Priority Health Medicare plan or the care you receive, call Customer Service right away. We will help you get started with:

• Coverage exceptions
  Learn how to make a formal request for us to cover a drug or medical service that is not normally covered under your plan.
• Appealing our decisions about your coverage
  Learn how to ask us to reconsider our decision if it is not in your favor.
• Filing service complaints (grievances)
  Learn how to complain about the service you receive from us or from our network of doctors, hospitals, pharmacies and other health care providers.

Information for health care providers

Here's who to contact for process or status questions related to grievances or other issues.
Go to the provider contacts listing Clicking this link will take you away from the prioritymedicare.com website.

Naming someone to help you

If you want someone else, like a spouse, child or friend, to act for you when you make a complaint or appeal a decision, you can sign a form that makes that person your official "authorized representative." Here's how:

1. Print the Appointment of Representative form. (120KB PDF)
2. Write in the name of the person you want to act for you. Sign and date the form.
3. Have your representative sign and date the form.
4. Mail the form to us at:
   
   Priority Health Medicare Service Coordinator
   1231 East Beltline NE, MS 1165
   Grand Rapids, MI 49525
   
   You can also deliver it in person at these locations, or fax it to us at 616 975-8880 or 942-0995, or call Customer Service.

Numbers of grievances and appeals

To find out the combined number of grievances, appeals and exceptions filed with Priority Health Medicare plans, call Customer Service.