An appeal is a request to review the organization determination we made. For example, you can file an appeal if we did not pay for emergency or urgently needed care or if we discontinued a service or type of care you think you need.
Appeals can be standard or fast. Standard appeals can take up to 30 days for a response. If you believe your health or ability to function could be hurt by waiting for a standard appeal, you may request a fast appeal. We will make a decision on a fast appeal within 72 hours.
If you wish to appeal a coverage decision for medical care, please contact Healthfirst Medicare Plan:
Monday through Sunday, 8am-8pm
Fast (Expedited) Appeal
Monday through Friday, 8:30am-5:30pm
Healthfirst Medicare Plan
Appeals and Grievances Unit
P.O. Box 5166
New York, NY 10274-5166
When we make an appeal, we review the coverage decision we made to check to see if we were following all of the rules properly. When we have completed the review, we give our decision.
If we say no to all or part of your Level 1 Appeal, you can go on to a Level 2 Appeal. The Level 2 Appeal is conducted by an independent organization that is not connected to our plan. If you are not satisfied with the decision at the Level 2 Appeal, you may be able to continue through several more levels of appeal.
For further information, please refer to Chapter 9 of your Evidence of Coverage with links provided at the bottom of this page.