Innovation Health Medicare

If you were covered by an Innovation Health^® Medicare Advantage plan in 2021, you should have received a notice in the mail letting you know that our Medicare Advantage plans are no longer available and to select a new plan.

For help selecting a new plan, go to Medicare.gov or call 1-800-633-4227 (TTY: 1-877-486-2048).

As a former Innovation Health Medicare member, you can access your online account, find forms and view information about your past coverage.

Member notices

View past coverage & benefits

Find your plan information

Choose an Innovation Health-Aetna Medicare plan to see 2021 plan documents.

2021 PLANS

Get a form

Access forms for claims and reimbursement or filing appeals.

Prescription Drug Claim Form

Prescription Drug Claim Form - Español

Print and complete this form for medical, dental, vision, hearing, or vaccine reimbursement.

Fill out this form if you were billed directly by a provider and would like to request reimbursement for medical care (includes dental, vision, hearing and vaccines). Don’t use this form for prescription drug reimbursement.

Medical, Dental, Vision, Hearing, or Vaccine Reimbursement Form

Medical, Dental, Vision, Hearing, or Vaccine Reimbursement Form (Español)

No printer? No problem. Learn what to send us for reimbursement.

Instructions if you can’t print the medical reimbursement form

Instructions if you can’t print the medical reimbursement form (Español)

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.

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

SELECT TOPIC

Results for > Medical care benefits or coverage

How to ask for medical coverage or request an appeal for a service

If you have a Medicare Advantage plan and you’re requesting a medical service, you’ll ask for a coverage decision (organization determination).

You can call us, fax or mail your information.

Call: 1-855-577-4436 ${tty}, ${hours}

Fax: 1-859-455-8650

Mail: Innovation Health Precertification Unit
P.O. Box 14079
Lexington, KY 40512-4079

When you'll hear back

We’ll get back to you within:

14 days if you submit your request before the service is performed (72 hours if you request a faster decision)
60 days if you submit your request after the service (there’s no option for a faster decision after service)

If we don't cover or pay for your medical benefits or services, you can appeal our decision.

If we don't cover or pay for your medical benefits or services (Medicare Part C), you can appeal our decision. Submit the online form, fax or mail your request to us.

Submit an authorization appeal online

Submit a claim denial appeal online

Print an authorization appeal form

Print a claim denial appeal form

Fax: 1-724-741-4953

Mail: Innovation Health Medicare Part C Appeals & Grievances
PO Box 14067
Lexington, KY 40512

If you need a faster (expedited) decision, you can call or fax us.

Expedited phone line: 1-855-249-1282 ${tty}

We're available 7 days a week, 8 a.m. to 8 p.m.

Expedited fax line: 1-724-741-4958

To send a complaint to Medicare, complete the Medicare Electronic Complaint form.

When you'll hear back

We’ll get back to you within:

30 days if you submit your appeal before the service is performed (72 hours if you request a faster decision)
60 days after a claim denial (there’s no option for a faster decision)

Results for > Prescription drug benefits or coverage

How to ask for prescription drug coverage or request an appeal

If you're requesting coverage of a medication under your Medicare Advantage plan, or if you’re asking for advance approval to fill a prescription, you'll ask for a coverage decision or exception request (determination).

Your doctor can request coverage on your behalf

Your doctor can call us at 1-800-414-2386 ${tty}, Monday to Friday, 8 a.m. to 11 p.m. ET, to request drug coverage. Or your doctor can fax a completed, signed form with a statement of medical necessity to 1-800-408-2386.

Or you can use one of these methods

You or your appointed representative can call us at 1-800-414-2386 ${tty}, Monday to Friday, 8 a.m. to 11 p.m. ET, to request drug coverage.

If you prefer, you can print and complete the appropriate forms below. Forms can be sent to us in one of three ways:

1. By fax: 1-800-408-2386

2. By mail:

Innovation Health Medicare
Coverage Determinations
P.O. Box 7773
London, KY 40742

3. You can also request coverage online.

Request coverage online

Print our drug coverage determination request form

Print the hospice drug coverage request under Part D form

You'll leave Innovation Health Medicare and go to the CMS website if you select the link below.

Print the Medicare program drug coverage determination request form

When you'll hear back

We’ll get back to you within 72 hours (24 hours if you request a faster decision).

If your request is denied, you can file an appeal.

If we deny your prescription drug request, you can appeal our decision. You can file your standard or expedited appeal using one of the below:

Online:

Appeal a denial online

Mail:
Innovation Health Medicare Part D Appeals & Grievance
PO Box 14579
Lexington, KY 40512

Download our appeals form

Download our appeals form - Español

You'll leave Innovation Health Medicare and go to the CMS website if you select the link below.

Download the Medicare program appeals form

Fax: 1-724-741-4954

Phone: 1-855-577-4432 ${tty}, 7 days a week, 24 hours a day

To send a complaint to Medicare, complete the Medicare Electronic Complaint form.

When you’ll hear back

We’ll get back to you within 7 days (72 hours if you request a faster decision).

You can contact the Medicare Beneficiary Ombudsman (MBO) for help 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.

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Innovation Health Medicare

Member notices

View past coverage & benefits

Find your plan information

Innovation Health-Aetna Medicare Connect (HMO) H2829-001

Innovation Health-Aetna Medicare Voyager (PPO) H1100-001

Innovation Health-Aetna Medicare Premier (PPO) H1100-002

Innovation Health-Aetna Medicare Eagle (HMO) H2829-002

Get a form

Results for > Medical care benefits or coverage

Results for > Prescription drug benefits or coverage

Your doctor can request coverage on your behalf

Or you can use one of these methods

When you’ll hear back

Results for > Inpatient hospital discharge

Results for > Home health, skilled nursing facility or rehabilitation facility care

Results for > Complaint about quality of care or any other services

When you’ll hear back

Results for > All other topics or concerns

Questions?

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