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Mercy MedicareADVANTAGE

Medicare Forms & Publications

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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Y0047_6456 v6 3_10
Approved xx/xx/10
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