Medicare Part D Prescription Benefits: File a Redetermination/Appeal

 

An appeal to the plan about a Part D Drug Coverage Decision we made is called a Redetermination (Appeal). Use this process to ask us to review a Part D drug Coverage Decision made by us. You cannot request a Part D Redetermination (Appeal) if we have not issued a Coverage Determination.

Medicare Part D Benefits: File an Appeal

To start your Part D Redetermination (Appeal), you (or your representative or your doctor or other prescriber) must contact us. For a standard appeal:

Fax request to: 1-562-989-0958 

Mail request to:

SCAN Health Plan
Attention: Grievances and Appeals Department
P.O. Box 22644
Long Beach, CA 90801-5644

If you are asking for a fast appeal, write to us at the address above or call our Member Services Department.

Your written request should include the following information: 

  • Member Name
  • Member ID number - found on your SCAN membership card
  • Name of the Part D drug that you are asking us to review
  • Reason you do not agree with the initial Coverage Determination
  • Date of initial Coverage Determination notice
     

Or simply download, fill out and submit the following form:

SCAN Redetermination Request Form

For more detailed information on the appeal process please refer to your Evidence of Coverage or contact us.