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Who May Make a Request

Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact Us to learn how to name a representative.

Because we, Wellcare, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination. This form may be sent to us by mail or fax:

Address  Fax Number
 Wellcare Health Plans
P.O. Box 31383
Tampa, FL 33631
 1-866-388-1766

Expedited appeal requests can be made by phone at 1-888-550-5252.

Enrollee's Information ?

Enrollee's Contact Information

Requestor's Contact Information ?

Prescription Drug Information

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Prescriber's Information

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Awagandakami
Last Updated On: 5/23/2016
Dagiti Miembro ti Medicare: Saluadan ti bagim maipanggep iti panagkusit ken panagtakaw iti identidad iti Medicare Ipabpablaak ti Departamento ti Salun-at ken Opisina ti Pagalagadan ti Tao ti Inspektor Heneral iti U.S. ti wagas ti panagkusit a manginaig ti genetic a panageksamen. Adalen no kasano a saluadan ti bagim.
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