hat
Voye lèt la oswa Fòm Demann pou Redetèminasyon an nan Medicare Part C and Part D Appeals and Grievance Department PO Box 6103, MS CA124-0197, Cypress CA 90630-0023. Ou ka fakse lèt apèl ou an tou nan Medicare Part D Appeals and Grievances Department gratis nan 1-877-960-8235 oswa rele 1-877-614-0623 TTY 711. 8.a.m. – 8 p.m.: 7 jou Okt-Mas; L-V Avr-Sept. Ou dwe poste lèt ou nan 60 jou oplita apre dat yo te bay detèminasyon ki pa anfavè w lan, oswa nan 60 jou olita apre dat refi demann ranbousman an. Si w te rate dat limit 60 jou a, ou ka depoze yon apèl kanmenm si ou bay yon rezon valab ki fè ou te rate dat limit la.
eng
Send the letter or the Redetermination Request Form to the Medicare Part C and Part D Appeals and Grievance Department PO Box 6103, MS CA124-0197, Cypress CA 90630-0023.You may also fax your letter of appeal to the Medicare Part D Appeals and Grievances Department toll-free at 1-877-960-8235 or call 1-877-614-0623 TTY 711. 8.a.m. – 8 p.m.: 7 days Oct-Mar; M-F Apr-Sept. You must mail your letter within 60 days of the date the adverse determination was issues, or within 60 days from the date of the denial of reimbursement request. If you missed the 60-day deadline, you may still file your appeal if you provide a valid reason for missing the deadline.