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INITIAL DECISIONS, APPEALS AND GRIEVANCES

You, your prescriber, treating provider, or authorized representative may request an initial decision or appeal using the contact information in the table below. You or your authorized representative may also submit a grievance using the contact information below. For more information on how to authorize someone to represent you during an appeal, select the link: Appointment of Representative (Form CMS-1696 (11/15)).

For a complete description of these processes, refer to the section titled, "What to do if you have a problem or complaint (coverage decisions, appeals, complaints)," in your Evidence of Coverage. For more information about Prescription Drug (Medicare Part D) limitations and exceptions, including prescriptions needing prior authorization, those with quantity limits and those with step therapy criteria, please refer to the Senior Preferred Part D Formulary.

Check on the status of a request or grievance
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You may also check on the status of a request or grievance by calling one of the numbers listed below. 

How to request a report
You can request a report on the total number of grievances, appeals, and exceptions filed with Senior Preferred by calling Customer Service or sending a written request to our Customer Service Department at the address listed below.​​

Medicare Part C (Medical Care)

Initial Decisions, Appeals and Grievances


Medicare Part C Medical Care Initial Decisions

(Organization Determination)   

  • Contact us by telephone at (608) 775-8077 or (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through February 14 we are available Saturday and Sunday from 8 a.m. to 8 p.m.

  • Or, send written requests by mail to Senior Preferred - Medical Management Department, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 - or by fax to (608) 775-8003.


Medicare Part C Medical Care Appeals

(Reconsideration)  

  • Contact us by telephone at (608) 881-8284 or (800) 394-5566, extension 308284. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through February 14 we are available Saturday and Sunday from 8 a.m. to 8 p.m.

  • Or, send written requests by mail to Senior Preferred - Member Advocate, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 - or by fax to (608) 775-8060.

Medicare Part C Medical Care Grievances*

  • Contact us by telephone at (608) 775-8077 or (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through February 14 we are available Saturday and Sunday from 8 a.m. to 8 p.m.

  • Or, send written requests by mail to Senior Preferred - Customer Service, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 or by fax to (608) 775-8091.

  • For more information about Part C coverage decisions, appeals and complaints, please review your Evidence of Coverage (EOC). You can view your EOC here.


*A grievance is any complaint, other than one that involves a request for an initial determination or an appeal. Grievances do not involve problems related to approving or paying for services or Part D drugs. It is a type of complaint that you make if you have any other type of problem with Senior Preferred or one of our plan providers. Grievances also involve refusal of Senior Preferred to process an expedited organization determination or extending the time frame to make an organization determination or reconsideration.






Medicare Part D (Prescription Drug)

Initial Decisions, Appeals and Grievances


Medicare Part D Prescription Drug Initial Decisions

(Coverage Determination/Exception)   

  • Contact us by telephone at (608) 775-8031 or (800) 394-5566, extension 58031. We are available seven days a week, 24 hours per day. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice.
  • Or, send written requests by mail to Senior Preferred - Pharmacy Specialist, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 - or by fax to (608) 775-8790.
  • Coverage Determination Request Form - Usually, your prescriber will submit a request on your behalf. To request an initial Part D coverage determination or exception, please use the Coverage Determination Request Form.


Medicare Part D Prescription Drug Appeals

(Redetermination)  

  • Contact us by telephone at (608) 881-8284 or (800) 394-5566, extension 308284. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through February 14 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
  • Or, send written requests by mail to Senior Preferred - Member Advocate, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 - or by fax to (608) 775-8790.
  • Coverage Redetermination Request Form - To request a Part D redetermination, first-level appeal, please use the Coverage Redetermination Request Form.

Medicare Part D Prescription Drug Grievances*

  • Contact us by telephone at (608) 775-8077 or (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through February 14 we are available Saturday and Sunday from 8 a.m. to 8 p.m.

  • Or, send written requests by mail to Senior Preferred - Pharmacy Specialist, 1900 South Ave. - Mail Stop: NCA2-01, La Crosse, WI  54601 or by fax to (608) 775-8790.

  • For more information about Part C coverage decisions, appeals and complaints, please review your Evidence of Coverage (EOC). You can view your EOC within the My Plan page.


*A grievance is any complaint, other than one that involves a coverage determination, LIS or LEP determination or an appeal. Grievances do not involve problems related to approving or paying for services or Part D drugs. It is a type of complaint that you make if you have any other type of problem with Senior Preferred or one of our plan providers. Grievances also involve refusal of Senior Preferred to process an expedited coverage determination or extending the time frame to make a coverage determination or redetermination.

Contact Medicare
You can also contact the Centers for Medicare & Medicaid (CMS) directly using the information provided below (please note, these links take you out of the Senior Preferred website).

  • Direct access to the CMS Complaint Form (use this form to provide feedback directly to Medicare about a Medicare health plan or prescription drug plan, including Senior Preferred; if you would like to request an initial decision, appeal a Senior Preferred initial decision, or submit a grievance, we encourage you first to contact Gundersen Health Plan Senior Preferred at one of the phone numbers listed above.
  • Direct access to the CMS Ombudsman (the Office of the Medicare Ombudsman helps you with complaints, grievances, and information requests).

Contact Senior Preferred
You can find all Senior Preferred contact information here.

This webpage was updated on October 17, 2016.