Request for Redetermination of Medicare Prescription Drug Denial

Because we Alignment Health Plan HMO denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.

Coverage Redetermination Online Form

Or Click the below link to download a PDF copy of the Coverage Redetermination Form.

Coverage Redetermination

This form may be sent to us by mail or fax:

Address Alignment Health Plan Attn: Clinical Review Department 2900 Ames Crossing Road Eagan, MN 55121

Fax Number: 1-800-693-6703

Expedited appeal requests can be made by phone at 1-844-227-7616 (TTY: 711), 24 hours a day, seven days a week.