Who May Make a Request
Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.
Because we, Staywell, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for redetermination (appeal) of our decision. You may ask for a redetermination after the date of our Notice of Adverse Benefit Determination. This form may be sent to us by mail or fax:
Staywell Health Plan
Expedited appeal requests can be made by phone at 1-866-800-6111. If you need help, please call Customer Service. You can reach them at 1-866-334-7927 (TTY 1-877-247-6272).