hat
Voye lèt la oswa Fòm Demann pou Redetèminasyon an nan Medicare Part D Appeals and Grievance Department P.O. Box 6103 MS CA 124-097 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. 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. Oswa ou ka rele nou nan: 1-888-867-5511 TTY 711. Disponib 8 a.m. - 8 p.m. lè lokal, 7 jou pa semèn.
eng
Send the letter or the Redetermination Request Form to the Medicare Part D Appeals and Grievance Department P.O. Box 6103 MS CA 124-097 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. 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. Or you can call us at: 1-888-867-5511 TTY 711. Available 8 a.m. - 8 p.m. local time, 7 days a week.