How to file a Grievance, Request an organization determination, and an appeal

Whether your request is about benefits covered by Medicare or Medicaid, if you would like help deciding whether to use the Medicare process or the Medicaid process or both, please contact Member Services at 1-844-969-5366 (Toll-free) 711 (TTY) Monday-Sunday 8:00 am – 8:00 pm., October through March and Monday-Friday 8:00 am – 8:00 pm April through September

The type of request you are having:

  • For some types of requests, you need to use the process for coverage decisions and appeals.
  • For other types of requests, you need to use the process for making complaints.

These processes have been approved by Medicare. To ensure fairness and prompt handling of your requests, each process has a set of rules, procedures, and deadlines that must be followed by you and by us.

Asking for coverage decisions

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your medical services or drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay.

You or your doctor can call Member Services 1-844-969-5366 (Toll-free) 711 (TTY), Monday-Sunday 8:00 am – 8:00 pm., October through March and Monday-Friday 8:00 am – 8:00 pm April through September or send to the plan a letter asking for a coverage decision if your doctor is unsure whether we will cover a particular medical service or refuses to provide the medical care you think that you need.

Asking for an appeal

If we make 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 and change a coverage decision we have made.

Appeals may be submitted orally or in writing to the plan. If you need further assistance with the appeals process, you may contact Member Services.

Filing a grievance

You can file a grievance by calling Member Services at 1-844-969-5366 (Toll-free)
711 (TTY) Monday-Sunday 8:00 am – 8:00 pm., October through March and Monday-Friday 8:00 am – 8:00 pm April through September or you can send your grievance in writing to:

Leon Health, Inc.
Grievances and Appeals Department
8600 NW 41st St, suite 210
Doral, FL 33166

Do you need to file a complaint?

If you need to file a complaint with Medicare, you may file your complaint online by submitting the Centers for Medicare and Medicaid Services (CMS) Medicare complaint form at www.medicare.gov. You may also do so by calling CMS at 1-800-Medicare (800-633-4227).

Ready to Enroll with LEON Health?

As you prepare for Medicare, you’ll be faced with many important decisions. LEON Health wants to help you select the best options for your needs.

Enroll Today