Filing a Part D Grievance
A grievance is any complaint you may have other than one that involves a Coverage Determination. You must file a grievance either orally or in writing no later than 60 days after the event or incident that led to the grievance. These are some examples of the types of problems that may lead you to file a grievance:
- You feel that you are being encouraged to leave (disenroll from) SeniorCare Complete.
- There are problems with the service you receive.
- You wait too long on the phone or in the pharmacy.
- There are problems with the cleanliness or condition of pharmacy.
- You disagree with our decision not to give you a "fast" Coverage Determination or Appeal.
You will receive a response within:
- 24 hours if your grievance involves a refusal to give you a "fast" Coverage Determination or Appeal.
- 30 calendar days for all other grievances. We may extend the timeline by up to 14 calendar days if you ask for an extension or we justify a need for additional information and the delay is in your best interest.
If you have a grievance, you can call Member Services.
You can also mail your grievance to:
While we encourage you to contact South Country Health Alliance Member Services first when you have a grievance, you can also tell Medicare about your grievance directly by visiting the Medicare website (external link).
|SeniorCare Complete Member Materials|
|2022 Materials||Last Updated||2023 Materials|
|Enrollment Form||12/27/21||Coming Soon|
|Annual Notice of Changes||10/13/21|
|Summary of Benefits||10/13/21|
|List of Covered Drugs (Formulary)||12/01/22|
|Formulary Updates||12/01/22||Coming Soon|
|Provider and Pharmacy Directory||Web Page (internal link)||See link||Web Page (internal link)|
|LIS Premium Summary Chart||12/29/21|
|Medicare Star Ratings||PDF (English)|
|CMS Best Available Evidence Coverage||Web Page (external link)||Web Page (external link)|
|Covered Diabetic Testing Supplies||10/5/21|
H2419_5772 Accepted 8/9/21
SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance Program (Medicaid) to provide benefits of both programs to enrollees. Enrollment in either plan depends on contract renewal.