Member Appeal Request Form Download
Filed when you do not agree with a decision made by us regarding a request for coverage or payment of service you requested.
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Member Appeal Request |
- Complete all of the sections on the form, and sign.
- Gather copies of any documents that can help us understand the appeal.
- Send completed form and supporting documentation to:
Grievance & Appeals Department
Preferred Care Partners Health Plan
P. O. Box 566420
Miami, Florida 33256-6420
TOLL-FREE FAX: (866)261-1474
**NOTE requires Adobe Acrobat Reader.
Need assistance completing this form?
Contact our Appeals Department Monday - Friday from 9:00am to 5:00pm at
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(888)291-5721 - TOLL-FREE
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(866)261-1474 - TOLL-FREE FAX |
