HealthChoice Medicare Supplement Plans With and Without Part D
Grievance and Appeals Information

All Health and Dental Claims

If your health or dental claim is denied in whole or in part for any reason, you have the right to have that claim reviewed. Requests for review of your denied claim, along with any additional information you wish to provide, must be submitted in writing to the claims administrator:

HP Administrative Services, LLC
PO Box 24870
Oklahoma City, OK 73124-0870

or call the claims administrator at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.

If your claim remains denied after a claims review, you can appeal that decision to the Grievance Panel* by writing to:

The Legal Grievance Department
3545 NW 58 Street, Suite 110
Oklahoma City, OK  73112

or calling 1-405-717-8701 or toll-free 1-800-543-6044. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.

Pharmacy Claims – HealthChoice High, High Alternative, Basic, Basic Alternative, USA, and S-Account Plans

Please contact HealthChoice Member Services at 1-405-717-8780 or toll-free at 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.

If your claim remains denied after a claims review, you can appeal that decision to the Grievance Panel* by writing to:

The Legal Grievance Department
3545 NW 58 Street, Suite 110
Oklahoma City, OK  73112

or calling 1-405-717-8701 or toll-free 1-800-543-6044. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.

*The Grievance Panel is an independent review group established by statute [74 O.S. Section 1306(6)].

All requests for hearings must be filed within one year of the date you are notified of the denial of a claim, benefit, or coverage.

You can submit a request for a Grievance Panel hearing and represent yourself in these proceedings. If you are unable to submit a request for a Grievance Panel hearing yourself, only attorneys licensed to practice in Oklahoma are permitted to submit your hearing request for you, or to represent you through the hearing process [75 O. S. Section 310(5)].

All claim reviews and final decisions of the Grievance Panel are made as quickly as possible. After completing the claim review and grievance procedures, you can pursue an appeal in Oklahoma District Court.

Pharmacy Claims – HealthChoice Medicare Supplement Plans Without Part D

We encourage you to contact us as soon as possible if you have questions, concerns, or problems related to your prescription drug coverage. If your pharmacy claim is denied and you have questions concerning the denial, please contact Medco, 24 hours a day, 7 days a week, toll-free at 1-800-903-8113 or toll-free TDD 1-800-825-1230.

If you want to appeal a denied pharmacy claim based on clinical criteria provided by your physician, you can fax your written appeal to 1-405-717-8925 or mail it to:

OSEEGIB Pharmacy Unit
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112

If your appeal is denied, you have the right to file a grievance with OSEEGIB. Please follow the same procedures used when appealing a denied health claim.

Pharmacy Claims – HealthChoice Medicare Supplement Plans With Part D

A complete description of the grievance and appeal processes for Medicare Part D pharmacy claims is available in the Grievance and Appeals Guide for Pharmacy Benefits (Plans With Part D) or by calling HealthChoice Member Services, Monday through Friday, 7:30 a.m. to 4:30 p.m., Central time, at 1-405-717-8699 or toll-free 1-800-865-5142. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.

Please let us know if you have questions, concerns, or problems related to your Part D coverage.