Preferred Care

220 Alexander St.

Rochester, NY 14607

Medicare Part D Member Services:

(585) 327-2480
(800) 665-7924

TTY Users:
(585) 325-2629
(800) 252-2452

Hours:

Monday - Friday
7am to 8pm (ET)

Phone Only:

Saturday - Sunday
Nov 15 - March 1
8am to 8pm (ET)
Go to Formulary (Drug List)
2007 Abridged
Three-Tier
2007 Comprehensive
Three-Tier
 

Medicare Part D Grievances, Appeals and Exceptions

Preferred Care is committed to making your Medicare Part D Prescription Drug Coverage as easy as possible for you, and we want to be responsive to your concerns. Below are links to information -- or instructions for requesting information -- about the Preferred Care grievances, appeals, and exceptions processes.

Please review the following important information, then click a Formulary (Drug List) link on the left side of the page to continue.

 

Part D Grievances and Appeals

Click to View / Download
Description / Instructions
Grievances and Appeals Process You have the right to make a complaint if you have concerns or problems related to your coverage or care. “Appeals” and “grievances” are the two different types of complaints you can make.This document outlines how to make a complaint about a problem with Preferred Care or one of our providers.
You can name someone to ask for an "initial decision" about your medical care or payment appeal. The person you name would be your authorized representative. You must complete this statement to give this person legal permission to act as your authorized representative. See Section 11 of your Evidence of Coverage Booklet (contract) for information about how and where to submit the form.

 

Part D Exceptions

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Description / Instructions
Medicare Part D Prescription Drugs Exception Process These procedures have been established by Preferred Care to ensure that Medicare Part D enrollees have access to medically necessary Part D drugs.

If you are requesting an exception, you can fill out and return this form to Preferred Care. See Section 12 of your Evidence of Coverage Booklet (contract) for information about how and where to submit the form.

 

Leaving Preferred Care Gold/GoldAnywhere

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Description / Instructions
Leaving Preferred Care Gold/GoldAnywhere,
and Your Choices for Continuing Medicare 		Whether leaving Preferred Care Gold/GoldAnywhere is your choice or not, Section 13 of your Evidence of Coverage Booklet (contract) explains your Medicare coverage choices after you leave and the rules that apply.
Potential for Contract Termination If Preferred Care leaves the Medicare program or changes our service area so that it no longer includes the area in which you live, we will tell you in writing. If this happens, your membership in Preferred Care Gold/ GoldAnywhere will end, and you will have to change to another way of getting Medicare benefits. See Section 13 of your Evidence of Coverage Booklet (contract) for details.

 

You may request an aggregate (total) number of Preferred Care's grievances, appeals and exceptions by calling the Preferred Care Service Recovery Department, Monday through Friday, 7am – 8pm

(Eastern Time) at (585) 327-2480 or (800) 665-7924 . TTY users may call (585) 325-2629 or (800) 252-2452.

Physicians who have questions or inquiries regarding grievances, coverage determinations, and appeals may call (585) 327-2499 or
(800) 933-3920 x2499.

 

Last updated: October 20, 2006

   
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