Appeals & Grievances

Filing an Appeal or Grievance


We continually work to improve the quality of care and service that you receive as a member. We encourage you to let us know right away if you have questions, concerns, or problems related to covered services or the care you receive while you are a member of MedStar Medicare Choice by calling our Member Services Department at 855-222-1041 from 8 a.m. to 8 p.m., seven days a week.* TTY/TDD users should call 855-250-5604

You may also contact our Member Services Department to get information about the appeals and grievances process or to check on the status of your request.

  • Fax: 855-435-8762
  • Phone: Call our Member Services Department at 855-222-1041, from 8 a.m. to 8 p.m., seven days a week*. TTY/TDD users should call 855-250-5604.
  • Mail: MedStar Medicare Choice
    ATTN: Appeals and Grievances
    P.O. BOX 689
    Pittsburgh, PA 15230-9922

You may also complete a CMS Complaint Form to file a complaint.

For instructions on how to file an appeal or grievance, please select from the following links.

2017

If you reside in the District of Columbia 

Filing an Appeal or Grievance MedStar Medicare Choice (HMO)

Filing an Appeal or Grievance MedStar Medicare Choice Dual Advantage (HMO SNP)

Filing an Appeal or Grievance MedStar Medicare Choice Care Advantage (HMO SNP)

2017

If you reside in Maryland

Filing an Appeal or Grievance MedStar Medicare Choice (HMO)

Filing an Appeal or Grievance MedStar Medicare Choice Dual Advantage (HMO SNP)

Filing an Appeal or Grievance MedStar Medicare Choice Care Advantage (HMO SNP)


Organization Determinations

When a coverage decision involves your medical care, it is called an organization determination. To request for a coverage decision on medical care or service you want but have not received please call our Member Services Department at 855-222-1041, from 8:00 am to 8:00 pm, seven days a week, TTY users should call 855-250-5604.

Learn more about coverage determinations for your medical coverage by selecting an appropriate option below.

2017

If you reside in the District of Columbia or Maryland

MedStar Medicare Choice (HMO) Coverage Determination 

MedStar Medicare Choice Dual Advantage (HMO SNP) Coverage Determination

MedStar Medicare Choice Care Advantage (HMO SNP) Coverage Determination


Obtaining an Aggregate Number of Grievances, Appeals, and Exceptions Filed with MedStar Medicare Choice

To obtain the aggregate number of grievances, appeals, and exceptions filed with MedStar Medicare Choice, please call our Member Services Department at 855-222-1041 from 8 a.m. to 8 p.m.*, seven days a week. TTY/TDD users should call 855-250-5604.


Member Rights and Responsibilities

MedStar Medicare Choice members have rights and responsibilities when participating in health management programs or disenrolling from a MedStar Medicare Choice plan. Use the links below to learn more.

2017

If you reside in the District of Columbia or Maryland

MedStar Medicare Choice (HMO) Member Rights and Responsibilities

MedStar Medicare Choice Dual Advantage (HMO SNP) Member Rights and Responsibilities

MedStar Medicare Choice Care Advantage (HMO SNP) Member Rights and Responsibilities


Disenrollment Rights and Responsibilities

2017

If you reside in the District of Columbia or Maryland

MedStar Medicare Choice (HMO) Disenrollment Rights and Responsibilities

MedStar Medicare Choice Dual Advantage (HMO SNP) Disenrollment Rights and Responsibilities

MedStar Medicare Choice Care Advantage (HMO SNP) Disenrollment Rights and Responsibilities

Contract Termination Information – Coming Soon


Out-of-Network Coverage

If a member must seek care or pharmacy access outside the MedStar Medicare Choice network or service area, the member must take steps to ensure the care provided will be covered by our plan. Use the link below to learn more.

2017

If you reside in the District of Columbia or Maryland

MedStar Medicare Choice (HMO) Out-of-Network Coverage Information

MedStar Medicare Choice Dual Advantage (HMO SNP) Out-of-Network Coverage Information

MedStar Medicare Choice Care Advantage (HMO SNP) Out-of-Network Coverage Information

 

H9915_17_3090- Approved

Last Updated Date: 11/3/2016