Medicare Part D Benefits: File an Appeal
If you have a supporting statement from your prescriber, please print out the Medicare Part D Benefits appeals form and submit it with the statement. CLICK HERE for the appeals form.
Please print and mail your appeal form along with all supporting documentation via FAX to: 562-989-0958 or by mail to:
SCAN Health Plan
Attention: Grievance and Appeals Department
PO Box 22644
Long Beach, CA 90801-5644
**SCAN may reach out to you for documentation showing the authority to represent the enrollee (a completed Authorization of Representation Form CMS-1696 or a written equivalent).