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Part D Appeals

Part D Appeals – What is an appeal?

An appeal is the process to review a decision you may not like. The negative decision is called a coverage determination. You would file an appeal if you want us to review it again and change our mind about what Part D prescription drug benefits are covered for you or what we will pay for a prescription drug.

Filing an Appeal

You, your doctor, or your appointed representative may file an appeal in the following ways:

Call us: 1-866-549-8289 (TTY: 711)
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.

Mail: Our address is:
Buckeye Health Plan - MyCare Ohio
P. O. Box 31383
Tampa, FL 33631-3383
Fax: 1-866-388-1766

Complete a Request for Redetermination Form.

 

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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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