You have the right to file a complaint/grievance with the plan. You must file your complaint/grievance within 60 calendar days of the date of the event that led to your complaint/grievance. Some examples of why you might file a complaint/grievance include the following:
- You believe your plan’s customer service hours of operation should be different:
- You have to wait too long for your prescription.
- The pharmacy is charging you more than you think you should have to pay.
- The company offering your plan is sending you materials that you didn’t ask to get and aren’t related to the drug plan.
- The plan doesn’t give you a decision about a coverage determination or first level appeal (see “How to Appeal” number 1) within the required timeframe.
- The plan didn’t provide the required notices.
- The plan’s notices don’t follow Medicare rules.
If you want to file a grievance, you should know the following:
- You may file your grievance with the plan over the telephone or in writing.
- You must file a grievance within 60 calendar days of the date of the event that led to your grievance.
- You must be notified of the decision generally no later than 30 days after the plan receives the grievance.
- If the grievance relates to a plan’s refusal to expedite a coverage determination or redetermination and you haven’t yet purchased or received the drug, you must be notified of the decision no later than 24 hours after the plan receives the grievance.
