Request for Redetermination of Medicare Prescription Drug Denial
Because we (CareSource Advantage® Zero Premium (HMO), CareSource Advantage® (HMO) and CareSource Dual Advantage (HMO D-SNP)) denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination. This form may be sent to us by mail or fax:
ATTN: Medicare Appeals
P.O. Box 66588
St. Louis, MO 63166-6588
You may also ask us for an appeal through our website at: https://www.caresource.com/members/tools-resources/grievance-appeal/part-d-prescription-plan-rights/
Expedited appeal requests can be made by phone at:
- 1-844-607-2827 for CareSource Advantage® Zero Premium and CareSource Advantage® members, or
- 1-833-230-2020 (TTY: 711) for CareSource Dual Advantage™ members
If you have a hearing or speech impairment, please call TTY: 711. We are open 8 a.m. to 8 p.m. Monday through Friday and from October 1 through March 31, we are open the same hours, seven days a week.
Who May Make a Request: Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.