Coverage Decisions, Appeals, and Grievances

for Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage)

How do I file a grievance?

To file or check the status of a grievance or an appeal‚ the first step is to call Member Services. Member Services can also assist members with requests to obtain an aggregate number of grievances, appeals, and exceptions filed with the Plan/Part D sponsor.

Member Services

(877) 210-9167

(800) 984-3510

(855) 291-9336

Daily 8 a.m. to 8 p.m. local time
Voicemail used on holidays and weekends, April 1 to September 30

File by mail

If you do not wish to call or you called and were not satisfied, you can put your complaint in writing and send it to the address or fax below. Be sure to describe your complaint or use the link to the appeals and grievance form below.

FirstMedicare Direct
Attention: Appeals Department
42 Memorial Dr.
Pinehurst, NC 28374
Fax: (816) 313-3061

FirstMedicare Direct
Attention: Grievance Department
3310 Fields South Dr.
Champaign, IL 61822

The following document links contain detailed information on how to file an appeal, a grievance/complaint, or appoint a representative to file the complaint on your behalf and the link to the appeals and grievance form.

Appeals & Grievances Form

Appointing a Representative

What if I don’t want to file my complaint through FirstMedicare Direct?

You can also go directly through Medicare.gov or call (800) MEDICARE to file a complaint.

You can also get help with Medicare-related complaints, grievances, and information requests from Medicare's Ombudsman.

How do I request a coverage determination or medical exception for a drug?

You, your authorized representative, or your prescribing doctor can use our Coverage Determination Request Form to ask for a coverage determination. Send any additional chart notes in one of the following ways:

Mail

Attention: Pharmacy Department or Medical Management
3310 Fields South Dr.
Champaign, IL 61822
Email: MemberServices@firstcarolinacare.com
Fax: (217) 902-9798