Pharmacy (Part D) Coverage Determinations, Appeals and Grievances

You have a right to make a complaint if you have concerns or problems with any part of your care as an Aspirus Health Plan member. The Medicare program has established rules about what you need to do to make a complaint about Part D services or benefits and what Aspirus Health Plan is required to do when we receive a complaint. A complaint will be handled as a grievance, coverage determination, or an appeal, depending on the nature of the complaint.

Get more information

If you want more information about coverage determinations, filing an appeal or grievance, or appointing a representative, please use the links in the upper right column of this page.

Instructions for Appointing a Representative (PDF)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF)
Request for Medicare Prescription Drug Coverage Determination Form (PDF)
Appointment of Representative Form (CMS Form-1696)

Questions?

Call Aspirus Health Plan Customer Service if you:

  • Have questions about coverage determinations, appeals, or grievances.
  • Have questions about the status of a coverage determination request.

Local number: 715-631-7411 or 1-855-931-4850 toll free
TTY users call: 715-631-7413 or 1-855-931-4852 toll free

Coverage Determinations (PDF)
Get more information about coverage
determinations.

Appeals (PDF)
Learn more about appeals.

Grievances (PDF)
Find out more about grievances.

If you have questions about the status of an appeal or grievance request, please call Aspirus Health Plan Member Complaints

Phone

715-631-7440 local or 1-855-931-4858 toll free
TTY users call 715-631-7413
or 1-855-931-4852 toll free
8:00 am-4:30 pm, Monday – Friday.

Mailing address

Attn: Appeals and Grievances
Aspirus Health Plan
P.O. Box 51
Minneapolis, MN 55440-9972

Email

cagMA@aspirushealthplan.com

Fax

You can also fax your written complaint to us at 715-787-7325 or 1-855-931-4858 toll free.

Customer Service

715-631-7411 or 1-855–931-4850 toll free.
TTY: 715-631-7413 or 1-855-931-4852 toll free.

Appeals Form
Complaint Form

You can also file a complaint with Medicare using the Medicare Complaint Form (external site)

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