You have the right to appeal any decision about your services. This is true whether you are in the Original Medicare Plan, a Medicare managed care plan, or a Medicare prescription drug plan. If Easy Choice Health Plan (HMO) does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal.

2013 Benefit Year

2013 Appeals and Grievance Policy - Chinese (Download PDF)

2013 Appeals and Grievance Policy - English (Download PDF)

2013 Appeals and Grievance Policy - Korean (Download PDF)

2013 Appeals and Grievance Policy - Spanish (Download PDF)

2013 Appeals and Grievance Policy - Vietnamese (Download PDF)

2012 Benefit Year

2012 Appeals and Grievance Policy - Chinese (Download PDF)

2012 Appeals and Grievance Policy - English (Download PDF)

2012 Appeals and Grievance Policy - Korean (Download PDF)

2012 Appeals and Grievance Policy - Spanish (Download PDF)

2012 Appeals and Grievance Policy - Vietnamese (Download PDF)

Plan's Exceptions Process (Download PDF)

• CMS Appointment of Representation Form (Download PDF)
• Evidence of Coverage
• Medicare Reconsideration Request Form (Download PDF)
• Transfer (Assignment) Of Appeal Rights (Download PDF)
• Request for Medicare Hearing before an Administrative Law Judge (ALJ) (Download PDF)

(Download PDF)
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