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Member Benefits and Tools
Request an Appeal

If Jefferson Health Plans has denied coverage or payment for a prescription drug or medical service or item that you or your provider or prescriber requested, and you disagree with the decision, you have the right to appeal.

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Contents:

Prescription Drugs

About Appeals and Grievances

If you’re facing an issue with Jefferson Health Plans, please contact Member Relations at 1-833-422-4690 (TTY 1-877-454-8477) and we will work to resolve the issue.

If you believe that Jefferson Health Plans should pay for a service or benefit that has been denied, in whole or in part, or if you are disputing any cost sharing amounts you owe for an item or service, or a rescission of coverage decision, you have the right to appeal the decision. If you have any other type of complaint or problem with our plan, you can file a grievance.

How to Contact

  1. Verbal Appeal or Grievance

    2. You can call Member Relations at 1-833-422-4690 (TTY 1-877-454-8477) to file a verbal appeal or grievance.

    October 1 – March 31, we’re available 8 a.m. – 8 p.m. seven days a week
    April 1 – September 30, we’re available 8 a.m. – 8 p.m. Monday through Friday

  2. Written Appeal or Grievance

    3. You can send your appeal or grievance in writing to:

    Attn: Member Appeals Department/CGA Unit Jefferson Health Plans
    1101 Market Street, Suite 3000
    Philadelphia, PA 19107

    Grievances and appeals can also be faxed to 215-991-4105. If you would like to file an Expedited Appeal and it is outside of normal Member Relations hours of operation, please fax your expedited request to 215-991-4105. See appeal forms below.

Additional Resources

For Members: To appeal to Jefferson Health Plans use the internal appeal request form. To appeal to the Pennsylvania Insurance Department use the external appeal request form.

For Providers: expedited appeal request form