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Authorized Representative

If you need someone to file a grievance, coverage determination, organization determination, or appeal on your behalf, you can name a relative, friend, advocate, doctor, or anyone else as your appointed representative. If you want someone to act for you, then you and that person must sign and date a statement that gives the person legal permission to act as your appointed representative.

If you are requesting an organizational determination through an appointed representative, you should download the CMS-1696 Appointment of Representative Form (PDF), complete it and mail it to:

Part C (and Part B Drugs) Appeals, and
Part C and D Grievances:

Buckeye Health Plan - MyCare Ohio
Appeals and Grievances
Medicare Operations
7700 Forsyth Blvd.
St. Louis, MO 63105
Fax: 1-844-273-2671

Part D Appeals:

Buckeye Health Plan - MyCare Ohio
Medicare Part D Appeals
PO Box 31383
Tampa, FL 33631-3383
Fax: 1-866-388-1766

If you have questions, please call Member Services at 1-866-549-8289. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711. 

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Last updated: 10/01/2024
Material ID: H0022_WEBSITE_2025_Approved_11052024

Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Buckeye Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Buckeye members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-866-549-8289 (TTY: 711) or visit mmp.buckeyehealthplan.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email OH_MMP_EmailRequests@centene.com.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-549-8289 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-549-8289 (TTY: 711) de 8 a. m. a 8 p. m., de lunes a viernes. Luego del horario de atención, los fines de semana y los días feriados, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el próximo día hábil. La llamada es gratis.


Last updated: 10/01/2024
Material ID: H0022_WEBSITE_2025_Approved_11052024

Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Buckeye Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Buckeye members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-866-549-8289 (TTY: 711) or visit mmp.buckeyehealthplan.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email OH_MMP_EmailRequests@centene.com.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-549-8289 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-549-8289 (TTY: 711) de 8 a. m. a 8 p. m., de lunes a viernes. Luego del horario de atención, los fines de semana y los días feriados, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el próximo día hábil. La llamada es gratis.

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