Request for Redetermination of Medicare Prescription Drug Denial
Please submit this form to make a request for redetermination of Medicare prescription drug denial.
Because we, AmeriHealth, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.
Expedited appeal requests can be made by phone at 1-866-569-5190 (TTY/TDD: 711).
Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Please call us to learn how to name a representative.
To ensure your privacy, all information will be sent via a secure connection. AmeriHealth will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law.