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Get a form
Access forms for claims and reimbursement or filing appeals.
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.
No printer? No problem. Learn what to send us for reimbursement.
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
You can contact the Medicare Beneficiary Ombudsman (MBO) for help with a complaint, grievance or information request.
Innovation Health is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal.