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;
- Your receipt of, or payment for, a prescription drug that you believe may be covered;
- A tiering or formulary exception request;
- The amount that Bright Health requires you to pay for a Part D prescription drug and you disagree with the amount;
- A limit on the quantity (or dose) of a requested drug and you disagree with the requirement or dosage limitation;
- A requirement that you try another drug before Bright Health will pay for the requested drug and you disagree with the requirement; and
- A decision whether you have, or have not, satisfied a prior authorization or other utilization management requirement.
View accurate process and contact information .
Website Last Updated: Jan 13 2021