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How to File an Appeal for your Part C Benefits

Information Last Updated: 11/13/2018

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You have the right to submit an Appeal about the quality of care you received and/or reconsideration (appeal) when the Plan has made a coverage decision. If you don’t believe you’re receiving the services you’re entitled to, or if you are being asked to pay more than what you believe, you can send an Appeal to Brand New Day.

If you're filing an appeal related to your Part D Prescription Drugs, please click here to learn more.

Filing an Appeal for your Part C Benefits

 

If you received a “denial letter” about an organization decision and you are not satisfied with the decision, you can “appeal” the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. We review the coverage decision we made based on the additional information you provided. Your appeal is handled by different reviewers than those who made the original unfavorable decision. When we have completed the review we give you our decision.

If we say no to all or part of your appeal (Level 1) you can go on to a Level 2 appeal. The Level 2 appeal is conducted by an independent organization that is not connected to Brand New Day in any way. In some situations, your case will be automatically sent to the independent organization for a Level 2 appeal. If this happens, we will let you know. If you are not satisfied with the decision at the Level 2 appeal, you maybe able to continue through several more levels of appeal.

 

Member Services Department Contact Information

Send us your appeal through any of the following ways:
Call: 1-866-255-4795, TTY 711
Mail:

Brand New Day
Attn: Appeals and Grievances Department
PO Box 93122
Long Beach, CA 90809

Fax: 1-657-400-1217
Email: complaints@universalcare.com

For more detailed information about filing an appeal, see your Brand New Day Evidence of Coverage on this website or call and ask us send you a copy

Brand New Day is interested in hearing from you about what isn’t working as well as you would like it to. We are interested in complaints you may have about services you received, the way you were treated, the care you received (or didn’t receive in a timely manner), if you were charged incorrectly, or any other complaint you may have. We want to correct any inappropriate behavior, processes, or payments. You will not be "in trouble" or mistreated by us or your doctors if you complain - we are required to treat you fairly.

We’ll make sure of it. Your calls help us to improve. For more information on how to file a complaint and/or grievance,
please visit the File a Grievance site page.

 

If Brand New Day is not helping with your complaint, you can submit a complaint about Brand New Day directly to Medicare. Medicare takes your complaints seriously and will use the information to help improve the quality of the Medicare program.

To submit a complaint to Medicare, go to: https://www.medicare.gov/MedicareComplaintForm/home.aspx

If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call
1-800-MEDICARE (1-800-633-4227). TTY/TDD users can call 1-877-486-2048.