live life well.

MEMBER INSIGHT™ – Important Plan Information

Grievance, reconsideration, exceptions, coverage determination, and appeal rights and procedures

The Centers for Medicare and Medicaid Services audit appeals and grievance data is a comprehensive report on Member Medicare appeals and quality of care grievances data for Bravo Health, Inc.  The focus of this report is to provide information to our Members, as well as to assist in answering any questions in a proactive manner that the Member may have regarding it.

How to file a grievance and/or appeals

To request an oral determination (exceptions)/redetermination (expedited appeal) call:

Coverage Decisions for Part D Prescription Drugs
CALL 1-877-504-7252
Calls to this number are free.
TTY 1-800-964-2561
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free.

Appeals for Part D Prescription Drugs
CALL 1-877-504-7252
Calls to this number are free.
After hours, call 1-866-376-0741
TTY 1-800-964-2561
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free.

Complaints about Part D Prescription Drugs
CALL 1-877-504-7252
Calls to this number are free.
After hours, call 1-866-376-0741.
TTY 1-800-964-2561
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free.

To access more information on the grievance and appeals process and procedures specific to your Bravo Health plan, click here.

You may be able to get Extra Help to pay for your prescription drug premiums and costs.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy five (75) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227).
    TTY users should call 1-877-486-2048, 24 hours a day/7days a week;

  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday.
    TTY users should call, 1-800-325-0778; or

  • Your State Medicaid Office

The Federal Government has established periods when a person can join and change their Medicare prescription drug coverage. Unless you qualify for a special election period, you can change Medicare prescription drug plans once a year between November 15th and December 31st.

Medicare beneficiaries may be enrolled in only one Part D plan at a time. If you are enrolled in a Medicare Advantage (MA) coordinated care (HMO or PPO) plan or a Medicare Advantage Private-Fee-for-Service plan (PFFS) that includes Medicare Prescription Drugs, you may not enroll in a stand a lone Prescription Drug Plan unless you disenroll from the HMO, PPO, or MA PFFS plan. If you are enrolled in a Private Fee-for-Service plan that does not provide Medicare Prescription Drug coverage, or an MA Medical Savings Account (MSA) plan you may enroll in a PDP.

Eligible beneficiaries must use network or contracted pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies. Bravo Health’s mail-order service requires you to order at least a 31-day supply of the drug and no more than a 90-day supply. To get order forms and information about filling your prescriptions by mail, contact Member Services. If you use a mail order pharmacy not in the plan’s network, your prescription will not be covered.

You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Bravo Health will be responsible for the costs. For full information on Bravo Health benefits, call our Member Services Department at 1-866-442-7498.

Click here to see what your monthly plan premium would be based on your plan.

Coordination of Benefits / Direct Claim Form

Prior Authorization criteria

Information about drugs that require Prior Authorization (PA) or Step Therapy (ST) before being approved for coverage.

Plan transition policy

Information on how to receive a temporary supply of prescription drugs due to a change in coverage:

Information for members of Part D stand alone plans

Medicare beneficiaries may be enrolled in only one Part D plan at a time. If you are enrolled in a Medicare Advantage (MA) coordinated care (HMO or PPO) plan or a Medicare Advantage Private Fee-for-Service plan (PFFS) that includes Medicare Prescription Drugs, you may not enroll in a stand alone Prescription Drug Plan unless you disenroll from the HMO, PPO, or MA PFFS plan. If you are enrolled in a Private Fee-for-Service plan that does not provide Medicare Prescription Drug Coverage, or an MA Medical Savings Account (MSA) plan you may enroll in a PDP.

How to file a grievance and/or appeals

To access more information on the grievance and appeals process and procedures click here.

Pharmacy mail order form

Please use the appropriate link below to download the form.
Print the form, complete it, and follow the mailing instructions provided on the second page.