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Prescription Drug Appeals (Part D)

Prescription Drug Appeals (Part D) – What is an appeal?

An appeal is a way to ask us to change a coverage decision about your Part D prescription drug benefits.

We have seven calendar days to answer your standard appeal request.  For urgent or fast  (expedited) appeals, we will respond within 72 hours.

How to file an appeal

You, your physician, or your authorized representative may file an appeal in the following ways:

 Phone: 1-855-735-4398 (TTY:711)

Member Services hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal  holidays, you may be asked to leave a message. Your call will be returned within the next business day.

Fax: 1-866-388-1766

Mail:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Medicare Part D Appeals
P.O. Box 31383
Tampa, FL 33631-3383

fm.formularynavigator.com,medicare.entrykeyid.com,member.membersecurelogin.com,mmp.absolutetotalcare.com,absolutetotalcare.com,absolutetotalcare.entrykeyid.com,https://fm.formularynavigator.com,https://fm.formularynavigator.com/FBO/67/SC_2T_MMP_Comp_Form_22396.pdf, provider.mmp.absolutetotalcare.com,findaprovider.mmp.absolutetotalcare.com,

Last updated:  10/01/2024
Material ID:  H1723_WEBSITE_2025_Approved_11042024

Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.


Last updated:  10/01/2024
Material ID:  H1723_WEBSITE_2025_Approved_11042024

Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.