Part D Redetermination (Appeal)

Request a Redetermination

If 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.

2024 Plan Members

Please complete and submit the following secure online form

Download Part D Coverage Redetermination Form

2025 Plan Members

Please complete and submit the following secure online form

Download Part D Coverage Redetermination Form

Descargue el Formulario de Redeterminación de Cobertura de la Parte D

Expedited appeal requests can be made by phone at 1-800-707-8194.

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.