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Who May Make a Request

Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact Us to learn how to name a representative.

Because we, Wellcare, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.
Request for Redetermination of Medicare Prescription Drug Denial (Appeal)이 PDF 문서는 새로운 창에서 열립니다.  This form may be sent to us by mail or fax:

Address  Fax Number
 Wellcare Health Plans
P.O. Box 31383
Tampa, FL 33631
 1-866-388-1766

Expedited appeal requests can be made by phone at 1-888-550-5252.

If you or your prescriber believe that waiting 7 days for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 7 days could seriously harm your health, we will automatically give you a decision within 72 hours. If you do not obtain your prescriber's support for an expedited appeal, we will decide if your case requires a fast decision. You cannot request an expedited appeal if you are asking us to pay you back for a drug you already received.

Enrollee's Information ?

Enrollee's Contact Information

Requestor's Contact Information ?

Prescription Drug Information

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Prescriber's Information

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Last Updated On: 8/31/2016