Drug Benefit Questions and Concerns
CCHP wants you to be satisfied with the services you receive. We can help you resolve problems or issues you may have with your Medicare drug benefits. Please call our Member Services Center at 1-888-775-7888 (TTY users should call 1-877-681-8898) from 8:00 a.m. to 8:00 p.m., seven days a week whenever you have questions or concerns regarding your drug benefits. If our Member Services staff cannot resolve your complaint over the phone, you may file an appeal or a grievance. If you would like to obtain an aggregate number of grievances, appeals, and exceptions that have been filed with CCHP, please contact our Member Services Center by writing or calling.
Please call our CCHP Member Services Center if you disagree with a decision and you want to file an appeal. You have the right to appeal a decision within 60 days from the date of the denial notice (unless you show good cause for a delay past 60 days). You can file an appeal by using this form (PDF). However, the use of this form is not required. You, your appointed representative, or your physician can request a fast appeal.
You may file a "standard" appeal orally by telephone, or in writing, by fax or mail. CCHP will make a decision within 7 days after receiving your appeal.
You may ask for a "fast" appeal if waiting for a standard decision could seriously harm your health or your ability to regain maximum function. CCHP will make a decision within 72 hours.
Where to file Drug Benefit Appeals
To file an appeal, to ask questions about the process, or to check on the status of an appeal you have filed, call our Member Services Center. Our Member Services staff will answer your questions and guide you through the process. To file a fast appeal, you must call, send or fax your request to the Member Services Center. To file a standard appeal, you may fax or mail your appeal.
You can visit us in person at:
CCHP Member Services Center
845 Jackson Street,
San Francisco, CA 94133
Monday - Friday: 8:30 a.m. to 5:00 p.m.
Saturday: 9:00 a.m. to 5:00 p.m.
You can also call our Member Services Center from 8:00 a.m. to 8:00 p.m., seven days a week.
Toll-free Number: 1-888-775-7888
Where to File Drug Benefit Grievances
You may file a grievance orally by telephone or in writing by fax or mail. To file a grievance, to ask questions about the process, or to check on the status of a grievance you have filed, call our Member Services Center. Our Member Services staff will answer your questions and guide you through the process.
CCHP must notify you of the decision about your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after receiving your grievance. CCHP may extend the time frame by up to 14 calendar days if you request the extension, or if the Plan justifies a need for additional information and the delay is in your best interest. However, CCHP must respond to a grievance within 24 hours if: (1) the grievance involves a refusal by CCHP to grant your request for an expedited coverage determination or expedited redetermination, and (2) you have not yet purchased or received the drug that is in dispute.
Appointing A Representative
If you need assistance with these procedures, you can have someone act as your appointed representative. If you name an appointed representative, you may use this form (PDF). Both you and that person must sign and date an appointment of representative form that gives the person legal permission to act as your appointed representative. If you need help completing the form, please call our Member Services Center. As an alternative to this form, you can also provide CCHP with other appropriate legal documents supporting his or her status as your authorized representative.