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 or contact us or

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