Part C Appeals

Part C Appeals - What is an Appeal?

An appeal is a way for you to ask us to change a decision we made about your coverage. Making an appeal means trying to get the medical coverage you want.

Making an Appeal

You must make your appeal request within 60 days from the date on the written notice we sent to tell you our answer to your request for an organization determination. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal.

If you would like to file an appeal, 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 federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

You may also fax your written appeal to 1-844-273-2671 or mail it to this address:

Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan)
Appeals and Grievances
Medicare Operations
7700 Forsyth Blvd
Saint Louis, MO 63105

Please include the following:

• Your name
• Your address and phone number
• Your Member ID number
• Your reason for appeal

If you do not agree with our final choice, you can appeal to the State under its Fair Hearings system within thirty (30) days after the date on our written notice.

If you are appealing a service that is only covered by Ohio Medicaid and want your benefits to continue during the appeal, you will need to send your appeal within 10 days after you get the Notice of Adverse Action.

Please keep one copy of the fair hearing request for your information.

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 federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

How do non-contracted providers file a claim appeal?  

In accordance with the requirements established by the Centers for Medicare and Ohio Medicaid Services (CMS), non-contracted providers have Medicare appeal rights. Medicare appeal rights apply to any claim for which we have denied payment.

• All requests for payment appeals must include a completed and signed "Waiver of Liability" (WOL) statement.
• The appeals process cannot begin until a completed and signed WOL is received. Requests for appeals that do not include a WOL, or for which a WOL is not received within the requested time, will be issued a Notice of Dismissal of Appeal Request.
• Requests for payment appeals must be filed within 60 days of the explanation of payment (EOP).
• A copy of the EOP and any other proof (such as medical records when applicable) must be sent with the appeal request.
• We will make a decision regarding the appeal within 60 days from the date the appeal request was received with the completed Waiver of Liability.

Non-Contracted Provider Appeal Requests should be sent, with the completed WOL, to the following address:

Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan)
Attn: Appeals and Grievance- Medicare Operations
7700 Forsyth Blvd.
St. Louis, MO 63105 

Part C Appeals - What is an Appeal?

An appeal is a way for you to ask us to change a decision we made about your coverage. Making an appeal means trying to get the medical coverage you want.

Making an Appeal

You must make your appeal request within 65 days from the date on the written notice we sent to tell you our answer to your request for an organization determination. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal.

If you would like to file an appeal, 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 federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

You may also fax your written appeal to 1-844-273-2671 or mail it to this address:

Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan)
Appeals and Grievances
Medicare Operations
7700 Forsyth Blvd
Saint Louis, MO 63105

Please include the following:

• Your name
• Your address and phone number
• Your Member ID number
• Your reason for appeal

If you do not agree with our final choice, you can appeal to the State under its Fair Hearings system within thirty (30) days after the date on our written notice.

If you are appealing a service that is only covered by Ohio Medicaid and want your benefits to continue during the appeal, you will need to send your appeal within 10 days after you get the Notice of Adverse Action.

Please keep one copy of the fair hearing request for your information.

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 federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

How do non-contracted providers file a claim appeal?  

In accordance with the requirements established by the Centers for Medicare and Ohio Medicaid Services (CMS), non-contracted providers have Medicare appeal rights. Medicare appeal rights apply to any claim for which we have denied payment.

• All requests for payment appeals must include a completed and signed "Waiver of Liability" (WOL) statement.
• The appeals process cannot begin until a completed and signed WOL is received. Requests for appeals that do not include a WOL, or for which a WOL is not received within the requested time, will be issued a Notice of Dismissal of Appeal Request.
• Requests for payment appeals must be filed within 65 days of the explanation of payment (EOP).
• A copy of the EOP and any other proof (such as medical records when applicable) must be sent with the appeal request.
• We will make a decision regarding the appeal within 60 days from the date the appeal request was received with the completed Waiver of Liability.

Non-Contracted Provider Appeal Requests should be sent, with the completed WOL, to the following address:

Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan)
Attn: Appeals and Grievance- Medicare Operations
7700 Forsyth Blvd.
St. Louis, MO 63105