SilverScript Plan Support

SilverScript allows plan members to request Coverage Determinations, Redeterminations, make Appeals or file Grievances. SilverScript Medicare Part D plan support helps protect your rights as a SilverScript member and Medicare beneficiary.

Coverage Determinations Process

Another important part of SilverScript Medicare Part D plan support is the Coverage Determinations Process. Before purchasing a prescription drug, you have the right as a SilverScript member and Medicare beneficiary to get a written explanation (called a Coverage Determination) about your benefits. This includes whether a certain drug is covered, whether you have met the requirements to get a requested drug, how much you pay for a drug or whether to make an exception to a plan rule.

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Appeals Process

An Appeal is an action you can take if you disagree with a coverage or payment decision made by Medicare, or your Medicare prescription drug plan. It is your right as a SilverScript member and Medicare beneficiary to ask Medicare or your Medicare plan for a redetermination (a request to reconsider a decision made about your coverage). There are multiple levels of Appeals available to you if you disagree with a redetermination.

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Fraud, Waste and Abuse

Healthcare fraud is often called a victimless crime, but it really increases costs for everyone. SilverScript is committed to fighting healthcare Fraud, Waste and Abuse (FWA) with a dedicated FWA program whose mission is to protect our employees, our members, our providers, all related entities and the Medicare Trust Fund.

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A Grievance is a formal complaint you file with your Medicare plan regarding plan or pharmacy-related service issues. If you are unhappy with the way you were treated or experience poor customer service, you have the right as a SilverScript member and Medicare beneficiary to file a Grievance.

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How to Disenroll

Disenrollment from a Medicare plan is generally the result of enrolling in another Medicare plan during one of Medicare’s enrollment periods. In the event you want to disenroll from a Medicare stand-alone prescription drug plan in order to enroll in Original Medicare without a prescription drug benefit, you would need to submit a written disenrollment request to your prescription drug plan.

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Out-of-Network Coverage

Generally, you may use your SilverScript plan benefits only at pharmacies in your plan’s network. We may extend coverage for covered drugs purchased out of network if, for example, they were purchased for an illness while traveling in an area not served by a nearby in-network pharmacy. You will likely pay more for a covered drug at an out-of-network pharmacy; however, you may be reimbursed for the plan’s cost-sharing amount if we determine coverage should be extended.

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If you have questions about Medicare Part D plan support, please contact us today.