Member Grievance and Appeal Information 2023

Click here for 2024 Member Grievance and Appeal Information

If you do not agree with a decision made by Preferred Care Partners you can submit an appeal that is a formal way of asking us to review and change a coverage decision we have made.

You can make a complaint about us or one of our network pharmacies, including a complaint about the quality of your care. This type of complaint does not involve coverage or payment disputes.

You can download the form below and follow the steps listed to file your Grievance or Appeal.

1. Download the Grievance and Appeal Request Form
2. Include copies of documents that help support the appeal.
3. Mail or fax completed form and documentation to:

• Preferred Choice Dade (HMO)
• Preferred Choice Broward (HMO)
• Preferred Special Care Miami-Dade (HMO C-SNP)
• Preferred Choice Palm Beach (HMO)

	Preferred Care Partners, Inc. Appeals and Grievance Department PO Box 6106, MS CA 124-0157, Cypress, CA 90630-0016
	Standard Appeal: 1-866-231-7201 (TTY - 711) Toll-Free Expedite Appeal: 1-877-262-9203 (TTY - 711) Toll-Free
	Expedited Appeal: 1-866-373-1081

• Preferred Medicare Assist (HMO D-SNP)
• Preferred Medicare Assist Palm Beach (HMO D-SNP)

	Preferred Care Partners, Inc. Appeals and Grievance Department PO Box 6106, MS CA 124-0157, Cypress, CA 90630-0016
	Standard Appeal: 1-866-231-7201 (TTY - 711) Toll-Free Expedite Appeal: 1-877-262-9203 (TTY - 711) Toll-Free
	Expedited Appeal: 1-866-373-1081

	Preferred Care Partners, Inc. Part D Appeals and Grievance Department PO Box 6106, MS CA 124-0197, Cypress, CA 90630-0016
	Standard Appeal: 1-866-231-7201 (TTY - 711) Toll-Free Expedite Appeal: 1-800-595-9532 (TTY - 711) Toll-Free
	Standard Appeal: 1-866-308-6294 Expedited Appeal: 1-866-308-6296

As a member of our plan, you have the right to get several kind of information from us. This includes information about the number of appeals made by members and the plan's performance rating including how it has been rated by plan members and how it compares to other Medicare Advantage health plans. To file a complaint directly to CMS. https://www.medicare.gov/MedicareComplaintForm/home.aspx

 For detailed information on the process of filing a grievance or appeal and obtaining a coverage determination, refer to Chapter 9 of your Evidence of Coverage.