Quejas y apelaciones

¿Qué es una apelación?

Los miembros de Banner tienen derecho a presentar una reconsideración cuando Banner toma una decisión de cobertura y no están satisfechos con ella. Pueden apelarla. Una apelación es una forma formal de solicitarnos que revisemos nuevamente una decisión de cobertura y posiblemente modifiquemos la decisión inicial a su favor.

¿Quién puede presentar un recurso de apelación?

Usted, un representante designado o su proveedor pueden presentar una apelación en su en nombre de.

¿Cuándo se puede presentar un recurso de apelación?

Su solicitud debe presentarse dentro de los 60 días calendario a partir de la fecha impresa en la notificación escrita de denegación de la decisión de cobertura . Si no cumple con el plazo de tiempo para presentar la apelación y puede demostrar una causa justificada para ello, Banner considerará las circunstancias que impidieron la presentación oportuna de su solicitud. La entidad que solicite la prórroga por causa justificada debe presentar una solicitud por escrito e indicar el motivo de la demora.

¿Dónde se puede presentar un recurso?

Las apelaciones (Parte C), reconsideraciones o redeterminaciones de medicamento (Parte D) se pueden realizar por teléfono, correo postal, fax o correo electrónico.

Si necesita ayuda para presentar su apelación, llame a nuestro Centro de Atención al Cliente.

También puede presentar una apelación por escrito a la siguiente dirección:

Banner Medicare Advantage
Atención: Departamento de Quejas y Apelaciones
5255 E Williams Circle, Ste 2050, Tucson, AZ 85711
Fax: (866) 465-8340
Correo electrónico: [email protected]

información adicional

Tiene derecho a obtener un resumen de la información sobre las apelaciones, quejas y excepciones que haya presentado contra Banner. Llame a nuestro Centro de Atención al Cliente para solicitar esta información.

También puede presentar una queja u obtener información directamente de Medicare llamando al 1-800- Medicare (1-800-633-4227), disponible las 24 horas, los 7 días de la semana. Los usuarios de TTY/TDD deben llamar al 1-877-486-2048. También puede visitar el sitio web de Medicare .

Documentos relacionados

Formulario de quejas de Medicare   Inglés | Español

What is a grievance?

A grievance is a complaint. You can report a complaint about the quality of care, your health care providers, waiting times, Banner customer service, or any other concerns. 

Who can file a grievance?

You or someone on your behalf such as an appointed representative.

When can a grievance be filed?

Your grievance or complaint must be filed within 60 calendar days following the incident or issue.

Where can a grievance be filed?

If you need assistance filing your grievance, call our Customer Care Center.

You may also submit a grievance in writing at the address below:

Banner Medicare Advantage 
Attn: Grievance & Appeals Department 
2701 E. Elvira Road, Tucson, AZ 85756 
Fax: (866) 465-8340 
Email: BUHPGrievances&[email protected]

Grievance by Phone

If you call us and we cannot resolve your complaint over the phone, we will respond to your complaint within 30 calendar days from the date you file the complaint. If Banner needs more information to resolve the complaint, we can take up to 14 days more to respond to your complaint. We will notify you of the need for the 14-day extension and explain the reason for the extension and how this delay it is in your best interest. Banner will also provide instructions on how to file a “fast” or expedited complaint if you do not agree with our decision to take the extension.

Grievance in Writing

If you file a written grievance, have a complaint related to quality of care, or ask for a written response, Banner will respond to you in writing. 

Quality of Care Grievances

You have two options for filing a quality of care complaint. You may file your quality of care complaint directly with Banner Medicare Advantage and/or with the Quality Improvement Organization (QIO), Livanta.

QIO Contact Information is:
Livanta, LLC
Phone: (877) 588-1123; TTY users call (855) 887-6668                                                                
Hours of Operation: Monday-Friday: 9:00 a.m. - 5:00 p.m. (local time), 24-hour voicemail service is available
Mail: Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701-1105
Fax: Grievances to Livanta at (844) 420-6672

Additional Information

You have the right to get a summary of information about the appeals, grievances, and exceptions that you have filed against Banner. To request this information, call our Customer Care Center and ask for the Grievance and Appeals Department.

You may also file a complaint or get information directly from Medicare, by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, TTY/TDD users call 1-877-486-2048. You can also visit the Medicare website.

Related Documents

Medicare Complaint Form  English | Español

Your Rights

Banner Medicare Advantage must honor your rights as a member of the plan.

• We must provide information in a way that works for you (in languages other than English, in braille, in large print, or other alternate formats, etc).
• We must treat you with fairness and respect at all times.
• We must ensure that you get timely access to your covered services and drugs.
• We must protect the privacy of your personal health information.
• We must give you information about the plan, its network of providers, and your covered services.
• We must support your right to make decisions about your care.
• You have the right to make complaints and to ask us to reconsider decisions we have made.

Your Responsibilities

• Get familiar with your covered services and the rules you must follow to get these covered services.
• If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us.
• Tell your doctor and other health care providers that you are enrolled in our plan.
• Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
• Tell us if you move, as this may impact your benefits and coverage.

You may appoint an individual to act as your representative. With your written authorization, the appointed individual can do the following on your behalf:

• Make any request, such as file a grievance or an appeal, on your behalf.
• Present or gather evidence
• Obtain appeals information
• Receive any notice in connection with an appeal

A signed authorization form is required by Medicare for an individual to make some requests from Banner Medicare Advantage.

To request an Appointment of Representative (AOR) Form, please call our Customer Care Center

OR print out the form listed below. The form must be signed by you and by the person who you would like to act on your behalf. You must also give us a copy of the signed AOR form. Please see our Contact Us page if you need to ask us a question or would like to send your form to us.

Related Forms

Appointment of Representative Form  English | Español