Request for Redetermination of Medicare Prescription Drug Denial
If First Choice VIP Care Plus denies to cover or pay for a prescription drug, you or your representative can ask us to review our decision. This is called a redetermination or an appeal. Use this form to send us your appeal.
When we denied your drug, you received a Notice of Denial of Medicare Prescription Drug Coverage. You have 60 days from the date on that notice to send us your appeal.
Who may request an appeal
You may ask us for an appeal. The provider who prescribed your drug — your prescriber — may also ask us for an appeal on your behalf. If you want someone else to request an appeal for you, such as a family member or friend, they must be your representative. Contact us to learn how to name a representative.
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