Complaints, Coverage Decisions and Appeals Processes

Medicare Parts C and D

If you are a member of Optima Medicare HMO Plans, and you have a concern about your health plan, the quality of your care or your coverage for certain services, you may follow an established process to resolve your concern. You cannot be disenrolled from Optima Medicare plans or penalized in any way if you make a complaint, request a coverage determination or file an appeal.

More information about complaints, coverage decisions, and appeals can be found in the Evidence of Coverage - in order to view the correct documents for your area, please submit your zip to proceed.

Complaints, Coverage Decisions, and Appeals Forms and Websites

Who to Contact

Information about the number of Appeals, Grievances & Exceptions filed with Optima Medicare:

Optima Medicare 
Appeals Department
P.O. Box 62876
Virginia Beach, VA 23466-2876
Fax: 757-687-6232 or Toll-free Fax: 1-866-472-3920
Phone: 1-800-927-6048
TTY VA Relay Service 1-800-828-1140 or 711