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Part C appeals and grievances

Learn more about the medical appeals process or file a grievance.

Appeals for Part C

If you, your doctor, or your representative do not agree with the outcome of the initial organization determination, you can appeal the decision by requesting a reconsideration. Learn more about the medical appeals process by reviewing your plan's EOC.

If you are a Keystone 65 HMO/HMO-POS member, you can file a standard or expedited medical appeal by using one of the methods below.

If you are a Personal Choice 65SM PPO member, you can file a standard or expedited medical appeal by using one of the methods below.

Medical appeals information

For more information on the medical appeals process, please reference your plan's EOC or contact the Member Help Team.

 

Grievances for Part C

You may file a grievance if you have a complaint other than one that involves a coverage determination (see information on appeals above). You would file a grievance for any type of problem you might have with us or one of our network providers.

If you are a Keystone 65 HMO/HMO-POS member, you can file a standard or expedited grievance. Most standard grievances are answered within 30 calendar days. When you file an expedited grievance, we will give you an answer within 24 hours. You can file a standard or expedited grievance by using one of the methods below.

  • Call 1-800-645-3965 (TTY/TDD: 711).
    Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from April 1 through September 30, your call may be sent to voicemail.
  • Fax 1-888-289-3008.
  • Write Keystone 65 HMO
    Medicare Members Appeals Unit
    PO Box 13652
    Philadelphia, PA 19101-3652

If you are a Personal Choice 65SM PPO member, you can file a standard or expedited grievance. Most standard grievances are answered within 30 calendar days. When you file an expedited grievance, we will give you an answer within 24 hours. You can file a standard or expedited grievance by using one of the methods below.

  • Call 1-888-718-3333 (TTY/TDD: 711).
    Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from April 1 through September 30, your call may be sent to voicemail.
  • Fax 1-888-289-3008.
  • Write Personal Choice 65 PPO
    Medicare Members Appeals Unit
    PO Box 13652
    Philadelphia, PA 19101-3652

Medical grievances information

For more information on grievances, please reference your plan's EOC or contact the Member Help Team.

If you prefer to file an appeal or grievance through CMS, please complete the Medicare Complaint Form.

To obtain an aggregate number of grievances, appeals, and exceptions filed with IBX, please contact the Member Help Team.

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Website last updated: 7/2/2025