Medicare Part D coverage determinations and complaints (Appeals & Grievances).

Coverage determinations and exceptions

This section describes how you can exercise your right to request a Coverage Determination under your Bright Health Medicare Advantage plan. A coverage determination is any decision made by the Part D plan sponsor regarding;

  1. Your receipt of, or payment for, a prescription drug that you believe may be covered;
  2. A tiering or formulary exception request;
  3. The amount that Bright Health requires you to pay for a Part D prescription drug and you disagree with the amount;
  4. A limit on the quantity (or dose) of a requested drug and you disagree with the requirement or dosage limitation;
  5. A requirement that you try another drug before Bright Health will pay for the requested drug and you disagree with the requirement; and
  6. A decision whether you have, or have not, satisfied a prior authorization or other utilization management requirement.

To find a pharmacy near you, please click here. To find out if your prescriptions are covered under your plan, please click here.

View accurate process and contact information .

Website Last Updated: Sep 25 2020

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