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SCAN Health Plan is committed to maintaining high levels of member satisfaction.
We continuously strive to improve our services through member feedback. We
encourage our members who require assistance with problem solving, to call our
Member Services Department at 1-800-559-3500, 7:00 a.m. - 8:00 p.m., 7 days a
week. TTY users should call 1-800-735-2929). Another avenue is to use the
grievance process.
To find instructions on how to complete a grievance click here.
If your complaint is about a decision regarding the denial of services or
payment, please do not use this form. You will need to file an appeal. Please
refer to your Evidence of Coverage (EOC) for detailed instructions on how to
file an appeal or call SCAN Member Services at 1-800-559-3500, 7:00 a.m. - 8:00
p.m., 7 days a week. TTY users should call 1-800-735-2929.
You may use this form
when you have a complaint such as:
- The quality of services that you receive
- Office waiting times
- Physician behavior
- Adequacy of facilities
- Involuntary disenrollment issues
- Any other areas of dissatisfaction that do not include coverage decisions
If your physician or pharmacist tells you a certain prescription requires a
prior authorization or is exceeding a coverage limit, you may fill out the
coverage determination form and SCAN will assist in having your physician send
medical justification to Express Scripts to make a decision on whether to cover
your request. Otherwise you may contact SCAN Member Services at 800-559-3500
(TTY Users: call 800-735-2929) for additional assistance in making this
request.
A decision about whether SCAN will cover a Part D prescription drug can be a
“standard” coverage determination that is made within the standard timeframe
typically within 72 hours. You may ask for a fast decision only if your
physician believes that waiting for a standard decision could seriously harm
your health or your ability to function. Once a decision has been made, Express
Scripts will send a letter to you and your physician regarding the decision of
the coverage determination.
If your physician or pharmacist tells you a drug is non-formulary or requires a
tier exception, you may fill out a coverage determination form and SCAN will
assist in having your physician send medical justification to Express Scripts to
make a decision on whether to cover your request. Otherwise you may contact
SCAN Member Services at 800-559-3500 (TTY Users: call 800-735-2929) for
additional assistance in making this request.
A decision about whether SCAN will cover a non-formulary exception or tier
exception can be a “standard” coverage determination that is made within the
standard timeframe typically within 72 hours upon completed information. If
incomplete information is given, the turnaround time will be delayed for up to
14 days. You may ask for a fast decision only if your physician believes that
waiting for a standard decision could seriously harm your health or your ability
to function.
Once a decision has been made, Express Scripts will send a letter to you and
your physician regarding the decision of the coverage determination. To check
the status of a coverage determination or exception, please contact Member
Services at 800-559-3500.
Member Coverage Determination Link
Physician Coverage Determination Link
CMS# 062503 © 2003 SCAN - SCAN 75-2003
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