Grievances, Coverage Determination, Exceptions, and Appeals


PrimeTime Health Plan is committed to providing each member timely resolution for all questions, complaints, or concerns. If you ever have any issues with PrimeTime, your benefits, or our providers, please let us know so we can help.

Our representatives are available to assist you at 1-800-577-5084 (TTY: 1-800-617-7446.) Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – February 14, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)

If you would like to meet with a customer service representative in person, you can visit us during our office hours, Monday through Friday. Our office hours are 8:00 a.m. to 4:30 p.m.

Complaints/Grievances

You have the right to file a grievance orally or in writing.

Submit a Written Grievance to: Submit a Verbal Grievance to:
PrimeTime Health Plan
P.O. Box 6029
Canton, Ohio 44706
Fax: 330-363-3066
Or email us at: [email protected]
PrimeTime Health Plan
Customer Service

330-363-7407 or 800-577-5084
TTY: 1-800-617-7446.

PrimeTime Health Plan will not treat you differently for filing a complaint. Your health care benefits will not be affected.

PrimeTime Health Plan maintains information on the number of Grievances, Appeals and Exceptions that are made against us. This information can be obtained by writing to PrimeTime Health Plan at P.O. Box 6029, Canton, OH 44706.



For more information on coverage determinations, including exceptions, grievances, and appeals, please select one of the links below. This information is also available in Chapter 9 of your plan’s Evidence of Coverage.


Medical Determinations, Grievances, or Appeals Information

This section provides a brief summary of your rights to request coverage for care, services, or payments made for medical services and your right to file a grievance or appeal.


Prescription Drug Coverage Determinations, Grievances, or Appeals Information

This section provides a brief summary of your right to request coverage for prescription drugs and your right to file a grievance or appeal.


Medicare Prescription Drug Coverage Determination

Complete the Medicare Prescription Drug Coverage Determination Form to request a coverage decision for a Part D prescription drug. This form may be completed by a member or a provider. To initiate requests by phone, please contact our service center or send us an email to [email protected].


Request for Redetermination of Medicare Prescription Drug Coverage Denial

Complete the Request for Redetermination of Medicare Prescription Drug Coverage Form to request a redetermination (appeal) of a coverage determination decision. To initiate requests by phone, please contact our service center or send us an email to [email protected].


Appointment of Representative

If you choose a friend, relative, provider, or other person to be your representative, please complete and return this form. It must be signed by you and the representative acting on your behalf. You must give us a copy of the signed form.


Other Resources

PrimeTime cares about our member satisfaction. Please contact us (link to contact info above) so we can help. You can also submit a complaint directly to Medicare if you’d like by completing the Medicare Complaint Form. The office of the Medicare Ombudsman (OMO) helps you with complaints, grievance and information requests. Visit their site here.

Last updated: 10/01/2016