Medicare Advantage Members Appeals and Grievances

Who Can File a Grievance or Appeal?

You have the right to file an appeal or grievance regarding your treatment or prescriptions (if you have Part D coverage). You or your authorized representative may request an initial decision or appeal. Your prescriber or treating provider may also request it for you.

You can also authorize someone else to act on your behalf during an appeal. For information on how to authorize a representative during an appeal, see the Appointment of Representative document (Form CMS-1696 09/21).

For a complete description of these processes, refer to your Evidence of Coverage (EOC).

For more information about Medicare Part D prescription drug limitations and exceptions, please refer to the Quartz Medicare Advantage Part D Formulary. The formulary also provides information about prescriptions that require prior authorization, quantity limits, or step therapy.

Check on the status of a request or grievance

You may also check on the status of a request or grievance by calling us at (800) 394-5566.  

For people who are deaf, hard of hearing, or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. 

How to request a report

You can request a report on the total number of grievances, appeals, and exceptions filed with Quartz Medicare Advantage by calling Customer Service or sending a written request to our Customer Service Department at the address listed below.

Medicare Part C (Medical Care) Initial Decisions, Appeals, and Grievances

Medicare Part C Medical Care Initial Decisions (Organization Determination)

• Contact us by telephone at (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
• Or, send written requests by mail to Quartz Medicare Advantage (HMO) – Medical Management Department, 2650 Novation Parkway, Fitchburg, WI 53713 – or by fax to (608) 881-8397.

Medicare Part C Medical Care Appeals (Reconsideration)

• Contact us by telephone at (866) 569-2576. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
• Or, send written requests by mail to Quartz Medicare Advantage (HMO)- Appeals Specialist, 2650 Novation Parkway, Fitchburg, WI 53713, by fax to (608) 644-3500, or email to [email protected].

Medicare Part C Medical Care Grievances*

• Contact us by telephone at or (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
• Or, send written requests by mail to Quartz Medicare Advantage (HMO) – Customer Service, 2650 Novation Parkway, Fitchburg, WI 53713 or by fax to (608) 644-3500.
• For more information about Part C coverage decisions, appeals and complaints, please review your Evidence of Coverage (EOC). You can view your EOC by logging into MyChart.

*A grievance is any complaint, other than one that involves a request for an initial determination or an appeal. Grievances do not involve problems related to approving or paying for services or Part D drugs. It is a type of complaint that you make if you have any other type of problem with Quartz Medicare Advantage or one of our plan providers. Grievances also involve the refusal of Quartz Medicare Advantage to process an expedited organization determination or extending the time frame to make an organization determination or reconsideration.

Medicare Part D (Prescriptions Drug) Initial Decisions, Appeals, and Grievances

Medicare Part D Prescription Drug Initial Decisions  (Coverage Determination/Exception)

• Contact us by telephone at (800) 394-5566. We are available seven days a week, 24 hours per day. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice.
• Or, send written requests by mail to Quartz Medicare Advantage (HMO)- Pharmacy Specialist, 2650 Novation Parkway, Fitchburg, WI 53713 – or by fax to (608) 881-8398.
• Coverage Determination Request Form – Usually, your prescriber will submit a request on your behalf. To request an initial Part D coverage determination or exception, please use the Coverage Determination Request form.

Medicare Part D Prescription Drug Appeals
(Redetermination)

• Contact us by telephone at (866) 569-2576. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
• Or, send written requests to Quartz Medicare Advantage – Appeal Specialist, 2650 Novation Parkway, Fitchburg, WI 53713, by fax to (608) 644-3500, or email to [email protected].
• Coverage Redetermination Request Form -To request a Part D redetermination, first-level appeal, please use the Coverage Re-determination Request form.

Medicare Part D Prescription Drug Grievances*

• Contact us by telephone at (800) 394-5566. For people who are deaf, hard of hearing or speech impaired, please call TTY/TDD 711 or toll-free (800) 877-8973, or you may call through a video relay service company of your choice. We are available to assist you Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available Saturday and Sunday from 8 a.m. to 8 p.m.
• Or, send written requests by mail to Quartz Medicare Advantage (HMO) – Pharmacy Specialist, 2650 Novation Parkway, Fitchburg, WI 53713 or by fax to (608) 881-8398.
• For more information about Part D coverage decisions, appeals and complaints, please review your Evidence of Coverage (EOC). You can view your EOC by logging into MyChart.

*A grievance is any complaint, other than one that involves a coverage determination, LIS or LEP determinations, or an appeal. Grievances do not involve problems related to approving or paying for services or Part D drugs. It is a type of complaint that you make if you have any other type of problem with Quartz Medicare Advantage or one of our plan providers. Grievances also involve the refusal of Quartz Medicare Advantage to process an expedited organization determination or extending the time frame to make an organization determination or reconsideration.

Contact Medicare

You can also contact the Centers for Medicare & Medicaid (CMS) directly using the information provided below (please note, these links take you out of the Quartz Medicare Advantage website).

• Direct access to the CMS Complaint Form (use this form to provide feedback directly to Medicare about a Medicare health plan or prescription drug plan, including Quartz Medicare Advantage; if you would like to request an initial decision, appeal a Quartz Medicare Advantage initial decision, or submit a grievance, we encourage you first to contact Quartz Medicare Advantage at one of the phone numbers listed above.
• Direct access to the CMS Ombudsman (the Office of the Medicare Ombudsman helps you with complaints, grievances, and information requests).