You, your prescriber, treating provider, or authorized representative may request an initial decision or appeal using the contact information in the table below. You or your authorized representative may also submit a grievance using the contact information below. For more information on how to authorize someone to represent you during an appeal, select the link: Appointment of Representative (Form CMS-1696 (11/15).
For a complete description of these processes, refer to the section titled, "What to do if you have a problem or complaint (coverage decisions, appeals, complaints)," in your Evidence of Coverage. For more information about Prescription Drug (Medicare Part D) limitations and exceptions, including prescriptions needing prior authorization, those with quantity limits, and those with step therapy criteria, please refer to the Quartz Medicare Advantage Part D Formulary.
Check on the status of a request or grievance
You may also check on the status of a request or grievance by calling one of the numbers listed below.
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
(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, 840 Carolina Street, Sauk City, Wisconsin 53583 - or by fax to (608) 881-8397.
Medicare Part C Medical Care Appeals
(Reconsideration)
Contact us by telephone at (800) 394-5566, extension 308284. 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, 840 Carolina Street, Sauk City, Wisconsin 53583 - or by fax to (608) 644-3500.
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, 840 Carolina Street, Sauk City, Wisconsin 53583 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 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 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, 840 Carolina Street, Sauk City, Wisconsin 53583 - 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 (800) 394-5566, extension 308284. 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, 840 Carolina Street, Sauk City, WI 53583 - or by fax to (608) 644-3500.
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, 840 Carolina Street, Sauk City, Wisconsin 53583 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 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 refusal of Quartz Medicare Advantage to process an expedited coverage determination or extending the time frame to make a coverage determination or redetermination.
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).
