PatientName
MemberAddress
CityStateZip
Enrollee Name: | Enrollee ID Number: |
You Have the Right to an Expedited (Fast) Grievance
You have the right to file an expedited (fast)
fast
fast
We need up to 14 days to
reason_request
We need up to 14 more days to consider your appeal for a service.
reason_appeal
NOTE:
How to File an Expedited (Fast) Grievance
Call us at
You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week, for more information about the expedited grievance process.