How To File An Appeal

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’ll make sure of it.

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File An Appeal

If you received a “denial letter” about a coverage 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. When you make an appeal, we review the coverage decision we have made to see if we were following all of the rules properly. 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 may be able to continue through several more levels of appeal.

For more detailed information about filing Grievances or Appeals, see your Brand New Day Evidence of Coverage on this website or call and ask us to mail or email a copy to you. We can be reached at 1-866-255-4795 (TTY users dial 1-866-321-5955). from 8:00 a.m. to 8:00 p.m., Monday through Friday (and weekends from Oct. 1 through Feb. 14th).

Phone number: 1-866-255-4795
TTY call: 1-866-321-5955
Hours of operation: 8 a.m. – 8 p.m.
Monday through Friday and weekends (from Oct. 1 – Feb 14th)

Brand New Day
Appeals and Grievances.
5455 Garden Grove Blvd.
Westminster, CA 92683

If you prefer, you may FAX your appeal to:
1-657-400-1217

If Brand New Day is not helping with your complaint, you can submit a complaint about Brand New Day HMO directly to Medicare. To submit a complaint to Medicare, go to

https://www.medicare.gov/MedicareComplaintForm/home.aspx

Medicare takes your complaints seriously and will use the information to help improve the quality of the Medicare program. 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.