Request for Redetermination of Medicare Prescription Drug Denial
Because Senior Care Plus denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.
Please complete the form below and click submit.
First / Last name
Member #
Date of Birth
MM
/
DD
/
YYYY
Medication Name
Please explain your reason for appealing:
Verification
SUBMIT FORM
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