Filing an Appeal or Grievance
How to obtain the total number of grievances, appeals, and exceptions filed with UPMC for Life
We can give you the total number of grievances, appeals, and exceptions filed with UPMC for Life. If you would like this information, UPMC for Life HMO/PPO members can call our Member Services Department at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. UPMC for Life Complete Care (HMO SNP) members can call 1-800-606-8648 (TTY: 711), 24 hours a day, 7 days a week.
Prescription Drug Determination/Exception or Redetermination
UPMC
for Life members may ask for a coverage determination or redetermination (appeal) for a Part D prescription drug. Use the links below to learn more.
Determination/Exception Request
Members can request a coverage determination/exception by completing and signing the form below. It can be mailed or faxed to UPMC Health Plan. You may also call our Member Services Department to file an appeal, get information about this process, check on the status of a request, or obtain an aggregate number of appeals, grievances, and exceptions for our plan. Please contact us by:
- Phone: UPMC for Life HMO/PPO members can call our Member Services Department at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. UPMC for Life Complete Care (HMO SNP) members can call 1-800-606-8648 (TTY: 711) 24 hours a day, 7 days a week.
- Fax: 412-454-7722
- Mail: UPMC Health Plan Pharmacy Department
U.S. Steel Tower, 12th Floor
600 Grant Street
Pittsburgh, PA 15219
If you would like to appoint a person to act on behalf of the member, please
visit our Appointment of Representative page for more information.
Redetermination (Appeal) Request
Members can request a redetermination (appeal) by completing and signing one of the forms below. It can be mailed or faxed to UPMC Health Plan. You may also call our Member Services Department to file an appeal, get information about this process, check on the status of a request, or obtain an aggregate number of appeals, grievances, and exceptions for our plan. Please contact us by:
- Phone: UPMC for Life HMO/PPO members can call our Member Services Department at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. UPMC for Life Complete Care (HMO SNP) members can call 1-800-606-8648 24 hours a day, 7 days a week.
- Fax: 412-454-7920
- Mail: UPMC Health Plan
ATTN: Appeals and Grievances
PO BOX 2939
Pittsburgh, PA 15230-2939
If you would like to appoint a person to act on behalf of the member, please
visit our Appointment of Representative page for more information.