Skip to main content

Coverage Decisions, Appeals and Grievances

Process for Medicare coverage requests, appeals & complaints

We want to be your first stop if you have a concern about your coverage or care. Call us at the number on your member ID card. 

As an Innovation Health Medicare member, you have the right to:

  • Ask for coverage of a medical service or prescription drug. In some cases, we may allow exceptions for a service or drug that is normally not covered. 
  • File an appeal if your request is denied. An appeal is a formal way of asking us to review and change a coverage decision we made.  
  • File a complaint about the quality of care or other services you get from us or from a Medicare provider.
  • Appoint someone else to act on your behalf. 
    How to appoint a representative
There are different steps to take based on the type of request you have.
 

Choose a topic to help us find the right process for you 

You can contact the Medicare Beneficiary Ombudsman (MBO) for help with a complaint, grievance or information request.

Learn more about the ombudsman

You can contact the Medicare Beneficiary Ombudsman (MBO) for health with a complaint, grievance or information request.

Learn more about the ombudsman

 

 

Disclaimers

Innovation Health is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. 

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

       Y0123_4006_14184_M Accepted 9/2018

       Page last updated: Mon Oct 01 00:11:34 EDT 2018

You are now leaving the Innovation Health Medicare website.

The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, please click Close.

Close Continue >
You are now leaving the Innovation Health Medicare website.

The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, please click Close.

Close Continue
You are now leaving our Medicare website.

You are leaving our Medicare website and going to our non-Medicare website. If you do not intend to leave our site, please click 'Close.'

 

Close Continue
Log in or register on our secure member website

We'll forward you to My Innovation Health. Here you can:

  • - Send a secure message to Member Services
  • - Check your claims
  • - Get an ID card
  • - And more

Cancel Continue
Doctors & Hospitals

Select your plan: 

Close Continue >
Mental Health Providers

Select your plan:

Close