The resource information linked to the INTEGRIS Health Partners+ formulary web page pertaining to grievances, coverage decisions (including exceptions), and appeals processes are taken directly from the Evidence of Coverage (EOC) document Members receive at the beginning of each year. To print a copy of the current plan year Evidence of Coverage (EOC) for Choice, please click the link.
Click on a topic below for more information.
Located in Chapter 7, Section 9 of the EOC: Making Complaints
To submit a grievance verbally, contact Customer Service at:
405-810-2008 or
1-833-751-1141,
TTY/TDD: 1-800-722-0353,
Monday through Friday from 8:00 am to 8:00 pm.
To submit a formal grievance in writing, send to:
INTEGRIS Health Partners+
Attn: Grievance and Appeals Department
P.O. Box 3105
Tulsa, OK 74101-3105
Fax Number: 918-879-4048
Located in Chapter 7, Section 5 of the EOC: How to ask for a Coverage Decision or Make an Appeal.
To request a coverage decision verbally, contact Customer Service at 1-833-751-1141 or 405-810-2008 (local), TTY/TDD: 1-800-722-0353, Monday through Friday from 8:00 am to 8:00 pm.
To submit a request in writing, send to:
INTEGRIS Health Partners+
Attn: Customer Service
P.O. Box 3105
Tulsa, OK 74101-3105
Fax Number: 918-594-5250
Located in Chapter 7, Section 5 of the EOC: How to ask for a Coverage Decision or make an Appeal
If we make a coverage decision and you are not satisfied with this decision, you can "appeal" the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. A standardized appeal request form is available. However, you may submit your request in any format. To print this form, click on the following link:
To submit an appeal request in writing, sent to:
INTEGRIS Health Partners+
Attn: Grievance and Appeals Department
P.O. Box 3105
Tulsa, OK 74101-3105
Requests for appeals must be in writing unless the request is for a fast or expedited decision. Members must file their
appeal request within 60 calendar days from the date included on the notice of the coverage decision.
Exceptions may be granted if you have a good reason for missing the deadline.
To submit a fast appeal verbally, contact Customer Service at
1-833-751-1141 or
405-810-2008 (local);
TTY/TDD: 1-800-722-0353.
Monday through Friday from 8:00 am to 8:00 pm.
Fax Number: 918-879-4048
When you make an appeal, we review the coverage decision we have made to check to see if we were following all of the rules properly. Your appeal is handled by different reviewers than those who made the original unfavorable decision. When we complete the appeal review, we will give you our decision in writing.
Specific questions about grievances, coverage decisions and appeals can be answered by our Customer Service Department.
Contact Customer Service at: 405-810-2008 or 1-833-751-1141, TTY/TDD: 1-800-722-0353, Monday through Friday from 8:00 am to 8:00 pm.
Located in Chapter 7 of the EOC: What to do if you have a problem or complaint
If you have someone appealing our decision for you other than your doctor, your appeal must include an Appointment of Representative form authorizing this person to represent you. A standardized form is required to be completed to appoint a representative. To print this form, click on the following link:
This form is also available on Medicare's website at http://www.cms.hhs.gov/cmsforms/downloads/cms1696.pdf.
Instructions for completing the Appointment of Representative form:
| Section 1: | The member (beneficiary) completes the requested information in Section I including the name of the individual they appoint as their representative. The beneficiary’s signature is required. |
|---|---|
| Section 2: | This section is completed by the individual the beneficiary has named as their representative. The representative’s signature is required. |
| Section 3 and Section 4: | These sections may not apply. See page 2 of the form for further information. |
To submit a completed Appointment of Representation Form, send to:
INTEGRIS Health Partners+
Attn: Grievance and Appeals Department
P.O. Box 3105
Tulsa, OK 74101-3105
Fax Number: 918-879-4048
For information on how to obtain an aggregate number of grievances and appeals, contact Customer Service at: 405-810-2008 or 1-833-751-1141, TTY/TDD: 1-800-722-0353, Monday through Friday from 8:00 am to 8:00 pm.
For additional detail on coverage decision and appeals, the following sections in Chapter 7 are located in your 2022 Evidence of Coverage for Choice: