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Medicare Part D Prescription Benefits: File a Redetermination/Appeal

Category: File an 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.

Should you have appeal process or status questions, please contact Member Services at at 1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day. 

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