What is an appeal?

Banner members have the right to file a “reconsideration” when Banner makes a coverage decision and you are not satisfied with this decision, you can “appeal” the decision. An appeal is a formal way of asking us to review a coverage decision again and possibly change the initial decision in your favor.

Who can file an appeal?

You, an appointed representative, or your provider may file an appeal on your behalf.

When can an appeal be filed?

Your request must be filed within 60 calendar days from the date printed on the written coverage decision denial notice. If you miss the appeal filing time frame, and you can show good cause for missing the filing time frame for the reconsideration, Banner will consider the circumstances that prevented the timely filing of your request. The party requesting the extension for good cause, must file a written request and include the reason for the delay.

Where can an appeal be filed?

An appeal (Part C) Reconsiderations or Medication (Part D) Redeterminations can be made over the phone, mail, fax or e-mail. If you need assistance filing your appeal, call our Customer Care Center. You may also submit an appeal in writing at the address below:

Banner Medicare Advantage
Attn: Grievance & Appeals Department
5255 E Williams Circle, Ste 2050, Tucson, AZ 85711
Fax: (866) 465-8340
Email: BUHPGrievances&[email protected]

Medicare Complaint Form

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 file using the online form below.

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.