Appeals and Grievances
You can file a grievance if you’re unhappy with our service, plans or providers. You can also appeal a denial of payment, eligibility or other decision.
Forms
- Member Appeal and Grievance Form
- Reference Guide for Filing an Appeal
- Reference Guide for Filing a Grievance
- Request for Medicare Prescription Drug Determination
- Request for Redetermination of Medicare Prescription Drug Denial
- Medicare Complaint Form
Appointing a Representative
To select a representative, complete the Appointment of Representative form. Your representative will be able to act for you. You and the representative must sign the form. We will need a copy of the signed form.
Obtaining a Coverage Decision
Members can ask for a coverage decision about a service or drug. To request a rushed coverage decision, please contact us at 800.779.6962.
Standard coverage decisions must be in writing. Please send these requests to:
Prime Therapeutics LLC
Attn: Medicare Appeals Department
2900 Ames Crossing Road
Eagan, MN 55121
Obtaining Data on Appeals and Grievances
Members can receive a description of the plans’ total number of appeals and grievances received and how these cases were resolved. Contact us by phone or in writing.
BlueJourney HMO Appeals and Grievances (or)
BlueJourney PPO Appeals and Grievances
PO Box 779970
Harrisburg, PA 17177-9970