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Part C organizational determinations appeals and grievances

Get more information

For more information on appointing a representative requesting an authorization or submitting a request for reimbursement:

Aspirus Health Plan Medicare Advantage

Instructions for Appointing a Representative (PDF)
2022 Medicare Authorizations (PDF)
2023 Medicare Authorizations (PDF)
Medicare Claim Reimbursement Form (PDF)
Appointment of Representative Form (CMS Form-1696)

Appeals and Grievances

What is a grievance? (PDF)
Appeals form (PDF)
Complaint form (PDF)


Pharmacy (Part D) Coverage Determinations, Appeals and Grievances


Mailing address

Attn: Appeals and Grievances
Aspirus Health Plan
P.O. Box 51
Minneapolis, MN 55440-9972

Email

cagMA@aspirushealthplan.com

Fax

You can also fax your written complaint to us at 715.787.7439 or 1.855.931.4858.

Phone

715.631.7440 or 1.855.931.4858
TTY users call: 715.631.7413 or 1.855.931.4852

Customer service

715.631.7411 or 1.855.931.4850
TTY users call: 715.631.7413 or 1.855.931.4852.