Understanding Appeals (Reconsiderations) for Medical Care
You have the right to file an appeal if we deny coverage for an item or service. An appeal is a formal way of asking us to review and change an organization determination we have made. You may ask us for an expedited (fast) appeal if you believe that waiting for a decision could seriously put your life or health at risk, or affect your ability to regain maximum function. If your doctor makes or supports the expedited request, we must expedite our decision.
Send the written request for a standard or expedited appeals within 60 calendar days from the date of the notice of the organization determination (except when the filing time frame is extended). You must include the following:
- First name, last name, address, phone number, date of birth, and ConnectiCare ID number
- The name of the item or service you want your plan to cover.
- Reason why you are appealing.
- Your signature, or if someone is acting on your behalf, a completed Appointment of Representative Form CMS-1696 or a written equivalent (if it was not submitted at the organization determination level).
You should send any supporting documentation that you believe may help your case, including medical records, with your appeal request
Appeals for Medical Care
Medicare Appeals and Grievances
P.O. Box 4010
Farmington, CT 06034
Attention: Medicare Appeals Department
175 Scott Swamp Road, Farmington, CT 06034
Last Update 11/26/2018