An appeal to the plan about a Part D Drug Coverage Decision we made is called a Redetermination (Appeal). Use this process to ask us to review a Part D drug Coverage Decision made by us. You cannot request a Part D Redetermination (Appeal) if we have not issued a Coverage Determination.

To start your Part D Redetermination (Appeal), you (or your representative or your doctor or other prescriber) must contact us. For a standard appeal:

Fax request to: 1-562-989-0958

Mail request to:

VillageHealth Plan
Attention: Grievances and Appeals Department
P.O. Box 22644
Long Beach, CA 90801-5644

If you are asking for a fast appeal, write to us at the address above or call our Member Services Department.

Your written request should include the following information:

• Member Name
• Member ID number - found on your VillageHealth membership card
• Name of the Part D drug that you are asking us to review
• Reason you do not agree with the initial Coverage Determination
• Date of initial Coverage Determination notice

Or simply download, fill out and submit the following form:

VillageHealth Redetermination Request Form

For more detailed information on the appeal process please refer to your Evidence of Coverage.

Call VillageHealth Member services at 1-800-399-7226 for additional information. (TTY Users: 711). Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to March 31. From April 1 to September 30, hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.