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Request for Part D Redetermination
Because KelseyCare Advantage denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of your Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.
Who May Make a Request: Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.
Please complete and submit the following secure online form: