File a Grievance or Appeal

Your Medicare Rights

As a CareSource member, you have the right to submit a:

• Coverage Determination – A decision we make about the payment for a Part D drug or an exception to our formulary.
• Organization Determination – A decision we make about covering a medical service (Part C or Medicaid).
• Appeal – A request to reconsider and change the decision made or the action taken on services requested. An appeal is not the same as a complaint or grievance.
• Grievance – An official complaint. You can file a grievance or complaint at any time.

For more information, go to Chapter 9 of the Evidence of Coverage on our Plan Documents page.

We have more detailed information on these pages:

• Medicare Advantage Part C Medical Plan Rights

• Medicare Advantage Part D Prescription Drug Plan Rights
• Ending Your Membership