Medicare Part C Grievances, Coverage Decisions and Appeals Summary

The resource information linked to the CommunityCare Senior Health Plan formulary web page pertaining to grievances, coverage decisions (including exceptions), and appeals processes are taken directly from the 2025 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 Silver, please click the link.

Click on a topic below for more information.


Located in Chapter 7, Section 9 of the 2025 Evidence of Coverage: Making Complaints

To submit a grievance verbally, contact Customer Service at:
(918) 594-5323 or 1-800-642-8065, 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:
Senior Health Plan
Attn: Grievance & Appeals
P.O. Box 3327, Tulsa, OK 74101-3327

Fax Number: 918-879-4048

In person:
CommunityCare Senior Center
4720 S. Harvard, Suite 101
Tulsa, OK 74135

Located in Chapter 7, Section 5 of the 2025 Evidence of Coverage: Your medical care: How to ask for a coverage decision or make an appeal of a coverage decision.

To request a coverage decision verbally, contact Customer Service at 1-800-642-8065 or (918) 594-5323 (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:
Senior Health Plan
Attn: Grievance & Appeals
P.O. Box 3327, Tulsa, OK 74101-3327

Fax Number: 918-594-5250

In person:
CommunityCare Senior Center
4720 S. Harvard, Suite 101
Tulsa, OK 74135

Located in Chapter 7, Section 5 of the 2025 Evidence of Coverage: Your medical care: How to ask for a coverage decision or make an appeal of a coverage decision

If we make a coverage decision, whether before or after a benefit is received, and you are not satisfied, 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:
Senior Health Plan
Attn: Grievance & Appeals
P.O. Box 3327, Tulsa, OK 74101-3327


Requests for appeals must be in writing unless the request is for a fast or expedited decision. Members must file their appeal request within 65 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 1-800-642-8065 or (918) 594-5323 (local); TTY/TDD: 1-800-722-0353. Monday through Friday from 8:00 am to 8:00 pm.

Fax Number: 918-879-4048

In Person:
CommunityCare Senior Center
4720 S. Harvard, Suite 101
Tulsa, OK 74135


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: (918) 594-5323 or 1-800-642-8065, TTY/TDD: 1-800-722-0353, Monday through Friday from 8:00 am to 8:00 pm.

Located in Chapter 7 of the 2025 Evidence of Coverage: 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 or Power of Attorney documentation 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:
Senior Health Plan
Attn: Grievance & Appeals
P.O. Box 3327, Tulsa, OK 74101-3327

Fax Number: 918-879-4048

In person:
CommunityCare Senior Center
4720 S. Harvard, Suite 101
Tulsa, OK 74135
For information on how to obtain an aggregate number of grievances and appeals, contact Customer Service at: (918) 594-5323 or 1-800-642-8065, 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 2025 Evidence of Coverage for Senior Health Plan Silver:
  • Section 4 - A guide to the basics of coverage decisions and appeals.
  • Section 5 - Your medical care: How to ask for a coverage decision or make an appeal of a coverage decision.
  • Section 6 - How to ask us to cover a longer inpatient hospital stay if you think you are being discharged too soon.
  • Section 7 - How to ask us to keep covering certain medical services if you think your coverage is ending too soon.
  • Section 8 - Taking your appeal to Level 3 and beyond.
  • Section 9 - How to make a complaint about quality of care, waiting times, customer service, or other concerns.