Medicare Advantage Part D Prescription Drug Plan Rights

This section describes your Part D prescription plan rights including grievances, coverage determinations, exceptions and appeal processes. For more detailed information, refer to Chapter 9 of the Evidence of Coverage.

Filing a Part D Prescription Drug Grievance

There are rules for making different types of complaints in Medicare HMO Blue and Medicare PPO Blue plans coverage situations. The rules described here are for grievances or complaints you might have about your Medicare Advantage Part D prescription drug coverage. For information about our standalone Part D prescription plan, log on to Blue MedicareRx (PDP)SM.

You can file a grievance (complaint) for problems related to quality of care, waiting times, and Member Service problems.

See the following chart for other situations where you might file a grievance:

Grievance Filing Chart

You may use this chart to help you decide which situation applies to your circumstance:

File a Grievance

When:

  • You feel that you are being encouraged to leave or disenroll from your prescription drug plan

  • You have problems with the member service you receive

  • You disagree with our decision not to expedite your request for an expedited coverage determination or redetermination

Please reference your Evidence of Coverage for more examples of when to file grievances and other requests.

You may also contact Member Service at 1-800-200-4255 (TTY: 1-800-522-1254), as follows: from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, and from October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week.

How to File a Grievance for Our Medicare Advantage Plans

You may submit your grievance orally or in writing within 60 days of the event.

Filing an oral grievance

Contact Member Service at 1-800-200-4255 (TTY: 1-800-522-1254).

Filing a written grievance

Submit your grievance in writing within 60 days of the event or incident to:

Blue Cross Blue Shield of Massachusetts
Medicare Advantage Grievance Coordinator
P.O. Box 55007
Boston, MA 02205
Fax: 1-617-246-8506

In your letter, please include:

  • Your name, address, and membership number

  • Your signature or that of a designated representative

  • The date your letter is signed

  • A description of the event and the date on which it occurred

You will be notified of our decision about your grievance as quickly as your health condition allows, but generally no later than 30 calendar days after receiving your complaint. We may extend the time frame by 14 calendar days if you request an extension, or if more information is required to justify your grievance.

Medicare Complaint Form

You are now able to submit feedback about your Medicare health plan or prescription drug plan directly to Medicare using the form below. The Centers for Medicare & Medicaid Services (CMS) values your feedback and will use it to continue to improve the quality of the Medicare program. If you have any other feedback or concerns, or if this is an urgent matter, please call
1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.