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We do our best to ensure that everything goes smoothly for you regarding your Health New England Medicare Advantage plan. However, if you do need to contact us regarding an initial decision, appeal, or grievance, there are several ways to do this.
You, your prescriber, treating provider, or authorized representative may use the contact information below to:
For a complete description of these processes, refer to the section titled, "What to do if you have a problem or complaint (coverage decisions, appeals, complaints)," in your Evidence of Coverage document. If you would like to authorize someone to represent you during an appeal, view the Privacy Notice and Appointing a Representative page.
You can get your request started by calling us or filling out our Complaint Form and returning it to us by mail. Phone numbers and mailing addresses are listed below, based on the type of request you are making. Be sure to include your name and let us know if you are looking for an initial decision or appeal, checking the status of a request or grievance, or requesting a full report.
Contact us by phone: Local: (413) 787-0010 Toll-Free: (877) 443-3314 TTY/TDD: (800) 439-2370 8 a.m. to 8 p.m., 7 days a week Or, send written requests to: Health New England Medicare Advantage Plan Clinical Services Department One Monarch Place Springfield, MA 01144-1500 Fax: (413) 233-2700
To submit a request or check on the status of a request for an organization determination, contact Member Services. Usually, your plan provider will submit a request on your behalf. Your plan provider may also use the Prior Approval Request Form.
Contact us by phone: Local: (413) 787-0010 Toll-Free: (877) 443-3314 TTY/TDD: (800) 439-2370 8 a.m. to 8 p.m., 7 days a week Or, send written requests to: Health New England Complaints and Appeals Department One Monarch Place Suite 1500 Springfield, MA 01144-1500 Fax: (413) 233-2685
To submit a request or check on the status of a request for a coverage determination or redetermination, use the “Online Requests” button. Usually, your prescriber will submit a request on your behalf. You or your prescriber may also use the OptumRx Coverage Determination Request Form.
Contact our Pharmacy Benefit Manager, OptumRx, by telephone:
*If you have a grievance about your Medicare Part D prescription drug coverage, call or write HNE Medicare Advantage Member Services directly (see the contact information for the HNE Medicare Advantage Plan, Complaints and Appeals Department, above).
A grievance is any complaint, other than one that involves a request for an initial determination or an appeal. Grievances do not involve problems related to approving or paying for services or Part D drugs. It is a type of complaint that you make if you have any other type of problem with the HNE Medicare Advantage Plan or one of our plan providers.
Use the CMS Complaint Form to provide feedback directly to Medicare about a Medicare health plan or prescription drug plan, including Health New England Medicare Advantage. If you would like to request an initial decision, appeal a Health New England Medicare Advantage initial decision, or submit a grievance, we encourage you first to contact our Member Services team.
If you would like to file a marketing complaint, you can contact Health New England Medicare Advantage Member Services directly or call 1-800-MEDICARE (1-800-633-4227). If possible, please be prepared to provide a Medicare agent or broker name at the time of your call.
Last Updated on 10/1/23