SelectCare - Medicare Part D Plan
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Coverage Determinations & Exceptions - Member

What is a Coverage Determination?

A coverage determination is any decision (an approval or denial) that CCHP SelectCare (HMO) makes when you ask for coverage or payment of a drug that you believe CCHP SelectCare (HMO) should provide.

  • You or your physician and other prescribers can ask for a coverage determination.
  • You can also appoint someone (such as a relative) to request a coverage determination for you.
  • You can ask for a standard coverage determination, CCHP SelectCare (HMO) will give you a decision in 72 hours.
  • You can also ask for an expedited "fast" coverage determination if you or your physician or other prescriber believes that your health could be seriously harmed by waiting up to 72 hours for a decision, CCHP SelectCare (HMO) will give you an answer in 24 hours.

What type of Coverage Determination do I need?

There are different types of coverage determinations. Please click on the coverage determination type below for more information about the most commonly requested coverage determinations.

What can I do if my Coverage Determination is denied?

If CCHP SelectCare (HMO) denies your coverage determination you have the right to request a redetermination appeal. Please see our section on Appeals and Grievances for information about your appeal rights, or contact our Member Services Department 8:00 a.m. - 8:00 p.m., seven days a week.

Telephone: 1-877-661-6230 (Press 2)
TTY/TDD: 1-800-735-2929

Click here for more information on Appeals & Grievances.

 
 
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Last Modified: Wednesday, December 16, 2009 5:38:34 PM
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