Get Aarp Appeal Form

The Aarp Appeal Form allows users to request a redetermination of Medicare prescription drug denials. This guide provides clear, step-by-step instructions for completing the form online, ensuring a smooth filing process.

Follow the steps to fill out the Aarp Appeal Form effectively.

1. Press the ‘Get Form’ button to access the Aarp Appeal Form and open it in your preferred online document editor.
2. Begin with the enrollee's information. Fill in the enrollee's name, date of birth, address, city, state, zip code, and phone number accurately. Include their Plan ID number to facilitate the processing of the appeal.
3. If someone other than the enrollee is submitting the appeal, complete the requestor's information section. This includes their name, relationship to the enrollee, address, city, state, zip code, and phone number.
4. If a representative is making the appeal, ensure to attach the necessary representation documentation, such as a completed Authorization of Representation Form or equivalent.
5. Specify the prescription drug being appealed by entering the name, strength, quantity, and dose. Additionally, indicate whether the drug has been purchased pending the appeal and provide the purchase date and amount paid if applicable.
6. Complete the prescriber's information section, including their name, address, city, state, zip code, office phone, fax number, and contact person.
7. If necessary, select the expedited decision option and provide any supporting documentation from the prescriber if applicable.
8. Provide an explanation for the appeal in the designated section. Be thorough and attach any additional pages if needed, along with any relevant information such as medical records.
9. Finally, ensure that the person requesting the appeal signs and dates the form before submission.
10. Save the completed form, and then download, print, or share it via your chosen method to submit the appeal.

Complete the Aarp Appeal Form online today to take the next step in your appeal process.