See chapter 9 of your plan’s Evidence of Coverage (EOC). For data on the number of grievances and appeals for Dean Advantage, contact our Member Services at 1-877-232-7566 (TTYT: 711) from, 8 am to 8 pm, weekdays (year-round) and weekends (Oct. 1 – Feb. 14).
Coverage decisions are the first decision made by the plan on the medical care you are requesting or the drugs(s) or payment you need.
A standard coverage decision for medical care means we will give you an answer within 14 calendar days after we receive your request. A fast coverage decision means we will answer within 72 hours.
A standard coverage decision for drugs means we must give you our answer within 72 hours after we receive your request. For a fast coverage decision about the drug(s) or payment you need, we must give you our answer within 24 hours.
See the latest National Coverage Determination updates
Requesting a coverage decision
To request a coverage decision for medical care, drugs or payment, you, your appointed representative or physician should contact us by telephone, fax or mail at the contact info below:
You, your prescriber or member representative may ask for a coverage decision via secure email outlined in the CMS drug coverage determination form
Submitting a paper claim
Mail or fax us a copy of the itemized prescription receipt along with a copy of the register receipt if available. Note: the register receipt alone is not adequate because it doesn’t have all pertinent information needed for reminbursement.
The itemized receipt should contain the following information:
- Pharmacy name, address, phone number
- Prescription (Rx) number
- Date of service
- Drug name
- National drug code (NDC)
- Quantity and day supply
- Provider name
- Member cost/responsibility
Dean Advantage Plans
Attn: Part D Member Claims Department
P.O. Box 1039
Appleton, WI 54912-1039
Fax: 1-855-673-6507 or local 920-221-4650