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Making an appeal
If Mercy Health Plans makes a coverage decision
and you are not satisfied with this decision, you can "appeal" the
decision. An appeal is a formal way of asking us to review and change
a coverage decision we have made. When you make an appeal, we review
the coverage decision we have made to see if we were being fair
and following all of the rules properly. When we have completed
the review we give you our decision.
If we say no to all or part of your Level 1
Appeal, you can go on to a Level 2 Appeal. The Level 2 Appeal is
conducted by an independent organization that is not connected to
our plan. If you are not satisfied with the decision at the Level
2 Appeal, you may be able to continue through several more levels
of appeal. Members may refer to their Evidence of Coverage for details
on further levels of appeals.
You can call us at our Customer Contact Center.
Eastern Missouri:
HMO: 800-280-1602,
PPO: 800-919-6459,
TTY: 800-468-4418.
Southwest Missouri:
HMO: 800-481-4466,
PPO: 866-875-0189,
TTY: 800-446-1468.
Arkansas:
800-919-6459
TTY: 800-468-4418
Written request can be mailed to the
following address:
14528 S. Outer Forty Rd.
Suite 300
Chesterfield MO 63017.
Requesting an exception
If a drug is not covered in the way you would
like it to be covered, you can ask the plan to make an "exception."
An exception is a type of coverage decision. Similar to other types
of coverage decisions, if we turn down your request for an exception,
you can appeal our decision.
When you ask for an exception, your doctor or
other prescriber will need to explain the medical reasons why you
need the exception approved.
For more information you can call our Customer
Contact Center at:
Eastern Missouri:
HMO: 800-280-1602,
PPO: 800-919-6459,
TTY: 800-468-4418.
Southwest Missouri:
HMO: 800-481-4466,
PPO: 866-875-0189,
TTY: 800-446-1468.
Arkansas:
800-919-6459
TTY: 800-468-4418
Written request can be mailed to the following
address:
14528 S Outer Forty Rd.
Suite 300
Chesterfield, MO 63017.
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