
Health Benefits (Members With and Without Part D)
If your health 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:
Medical Claims Review
PO Box 24870
Oklahoma City, OK 73124-0870
You may also call Medical Claims Review 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 after a claim review, your claim remains denied, you may appeal that decision to the Grievance Panel.
For more information contact:
The Legal Grievance Department
3545 NW 58th Street, Suite 110
Oklahoma City, OK 73112
or call 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 Benefits (Members Without Part D)
If your pharmacy claim is denied and you have questions concerning the denial, please contact Medco’s Member Services toll-free at 1-800-903-8113. TDD users call 1-800-825-1230.
If you wish to appeal a denied pharmacy claim you may mail or fax your written appeal to:
OSEEGIB Pharmacy Unit
3545 NW 58th, Ste 110
Oklahoma City, OK 73112
Fax: 1-405-717-8925
If your appeal is denied, you have the right to file a grievance with OSEEGIB by following the same procedures used to appeal a denied health claim.
Pharmacy Benefits (Members With Part D)
If you have questions, concerns, or problemsrelated to your prescription drug coverage, contact:
HealthChoice Member Services:
1-405-717-8699 or 1-800-865-5142, or TDD at 1-405-949-2281 or 1-866-447-0436
If you have questions about a Coverage Determination(excluding Tier Exceptions), contact:
Medco:
1-800-753-2851, or TTY at 1-800-825-1230
If you have questions about a Tier ExceptionCoverage Determination, contact:
Medco:
1-800-841-5409, or TTY at 1-800-871-7138
If you have complaints about the Quality of Careyou have received under the Medicare Part D Pharmacy Program, contact one of the following organizations:
Medco:
1-800-590-6828, or TTY at 1-800-716-3231
HealthChoice:
1-405-717-8699 or 1-800-865-5142, or TDD at 1-405-949-2281 or 1-866-447-0436
Centers for Medicare & Medicaid Services, Dallas, TX:
1-214-767-6401, or TTY 1-877-486-2048