SilverScript Medicare Part D Grievances

What is a Grievance?

A Grievance is a formal complaint you file with your plan. Valid reasons for filing a Grievance include:

  • You believe someone shared information about you that you feel should be confidential.
  • You experience poor customer service or are unhappy with how you have been treated.
  • You believe you were encouraged to leave the plan.
  • You were kept waiting too long by a pharmacist or by the plan’s Customer Care.
  • You are unhappy with the cleanliness or condition of a pharmacy.
  • You believe the plan’s written information is confusing or too hard to understand.
  • You believe plan marketing or sales activities to be inappropriate.
  • You suspect any type of fraud or abuse.
  • You are unhappy with the quality of the care you received.

What is the difference between a Grievance and an Appeal?

SilverScript Medicare Part D Grievances are filed when you experience any of the issues listed under “What is a Grievance?” For problems or complaints related to your benefits, your coverage or payment, use the Appeals process. Whether you use the Grievance or Appeals process depends on the type of complaint.

How do I file a Standard Grievance?

Usually, calling Customer Care is the first step for SilverScript Medicare Part D Grievance support. We will try to resolve your complaint over the phone. If there is anything else you need to do, Customer Care will let you know. If you wish to request an aggregate number of Grievances, Appeals and Exceptions filed, please call our toll-free Customer Care Grievance Line at 1-866-884-9478, 24 hours a day, 7 days a week. TTY users call 711.

If you do not wish to call (or you called and were not satisfied with the result), you can put your complaint in writing and mail or fax it to us, and we will reply with a written response, generally within 30 days.

  • Fax your Grievance to us using our toll-free fax number: 1-866-217-3353
  • Mail your Grievance to:
    SilverScript Insurance Company
    PO Box 30016
    Pittsburgh, PA 15222-0330

What information do I need to provide when I file a Grievance?

Filing SilverScript Medicare Part D Grievances requires all of the following information:

  • Your name
  • Your Member ID number
  • The nature and specific reason for the Grievance
  • The date the complaint or incident resulting in the Grievance occurred
  • Your telephone number and address (so we may notify you of our decision)

Is there a time limit for filing a Grievance?

Yes. You must file your Grievance within 60 calendar days from the date the incident that caused the Grievance occurred. Grievances filed after the 60-day period will not be accepted. You will receive a response to your grievance no later than 30 days from the date we receive the grievance. If we receive the grievance in writing we will reply with a written response.

How do I file an expedited (fast) Grievance?

If your Grievance involves a refusal by SilverScript to grant your request for an Expedited (fast) Coverage Decision or an Expedited (fast) Redetermination regarding a prescription drug—and you have not yet received the disputed drug—you may file an Expedited Grievance by calling Customer Care. We will respond within 24 hours from receipt.

Note: Please do not mail an expedited Grievance as we cannot guarantee a response within 24 hours. Contact our toll-free Grievance line at 1-866-884-9478, 24 hours a day, 7 days a week. TTY users call 711. You may fax your written Grievance to us using our toll-free fax number, 1-866-217-3353.

How soon can I expect a decision in response to a Grievance?

How quickly we decide on your Grievance depends on the type of Grievance you submit:

  • If you file a Standard Grievance
    We have up to 30 calendar days after receiving it to make a decision. Rarely, but in some cases, we may notify you that we need additional time to research the Grievance. If we believe it is in your best interest for us to continue researching the Grievance, we may ask for up to an additional 14 days. 

  • If you file an Expedited Grievance
    If we grant your request for an Expedited Grievance, you will receive a response within 24 hours from the time we receive your Grievance.

How will you notify me of your decision?

We will notify you or your Appointed Representative one of two ways:

  • If you filed your Grievance by phone
    We will call you or your Appointed Representative. 

  • If you mailed or faxed a written Grievance 
    We will notify you or your Appointed Representative by letter.

Note: See "What if I need help" for information about appointing a representative.

Is our decision final?

Yes. When you file SilverScript Medicare Part D Grievances and receive our answer, our decision is final and cannot be appealed. However, you always have the option to submit a complaint to Medicare in one of three ways:

If I need help, can I appoint a representative to act on my behalf when filing a Grievance?

Yes. You have the option to name another person (a representative that you designate) to act on your behalf when filing a Grievance.

You also have the right to hire a lawyer to act for you. You may contact your own lawyer, or get the name of a lawyer from your local Bar Association or other referral service. There are also groups that provide free legal services if you qualify. Remember, you are not required to hire a lawyer to file a Grievance.

How do I designate another person to be my Appointed Representative?

If you want to name a relative, friend, advocate, doctor, or anyone else to act for you as your Appointed Representative, you and that person will need to complete, sign and date the Appointment of Representative form (or an equivalent form or documentation) showing that the representative you designate is authorized to act on your behalf under state law.

Where do I send my Appointment of Representative Form?

When your Appointment of Representative form is completed and signed by you and the person you designate, please mail it to:

SilverScript Insurance Company
PO BOX 30016
Pittsburgh, PA 15222-0330

Or you can fax it to: 1-866-552-6205

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