facebook pixel code
Attention: Prevent the spread of coronavirus and protect yourself. Zing Health Plan Members and our AmaZING health community can learn more here. Attention: Prevent the spread of coronavirus and protect yourself. Zing Health Plan Members and our AmaZING health community can learn more here. Attention: Prevent the spread of coronavirus and protect yourself. Zing Health Plan Members and our AmaZING health community can learn more here. Attention: Prevent the spread of coronavirus and protect yourself. Zing Health Plan Members and our AmaZING health community can learn more here.

Coverage Decisions, Appeals and Grievances for Medical Care and Part D Prescription Drugs

Asking for a Coverage Decision for Medical Care or Part D Prescription Drugs

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your medical services and Part D prescription drugs. When a coverage decision involves your medical care, it is called an "organization determination." When a coverage decision involves your Part D prescriptions drugs, it is called a “coverage determination.”

You have a right to ask us to provide or pay for items, services, or Part D prescription drugs you think should be covered, provided or continued.

If you want to know if we will cover a medical service or Part D prescription drug before you get it, you, an authorized representative, or your physician/prescriber can ask us to make a coverage decision for you. A coverage decision is made about your benefits and coverage or about the amount we will pay for your medical services or drugs.

You, an authorized representative, or your physician/prescriber can ask for a coverage decision if you aren’t sure if your plan covers a medical service or Part D prescription drug, or if care is refused for a medical service or Part D prescription drugs you think that you need.

We are making a coverage decision for you whenever we decide what is covered for you and how much we pay. In some cases, we might decide a service or drug is not covered or is no longer covered by Medicare for you. If you disagree with this coverage decision, you can make an appeal.

You may request a coverage decision by calling Customer Service toll free at:

Zing Health: 1-866-946-4458 TTY 711

You can call us 8 a.m. to 8 p.m. seven days a week (except Thanksgiving and Christmas) from October 1 – March 31 and 8 a.m. to 8 p.m. Monday – Friday (other technologies such as voicemail are used after hours, weekends, and on Federal Holidays) from April 1 – September 30.
Customer Service also has free language interpreter services available for non-English speakers.

You may also send your request in writing to:

Coverage requests for Medical Care

Zing Health
Attn: Prior Authorization
303 W. Madison St., Ste. 800
Chicago, IL 60606

Fax: 1-844-946-4458

Email: prior_auth@myzinghealth.com

Coverage requests for Part D Prescription Drugs

Zing Choice IL (HMO)
PO Box 1039
Appleton, WI, 54912-1039

Fax: 1-855-668-8552

Email: customerservice@myzinghealth.com

You may submit your Part D prescription drug coverage request electronically here:

If you disagree with our Coverage Decision

If you disagree with this coverage decision, you can make an appeal. An appeal is a formal way of asking us to reconsider – and possibly change – a coverage decision we have made.

You, an authorized representative, or your physician/prescriber can request an appeal for coverage or payment of an item, medical service, or Part D prescription drug that you think should be covered.

You, your physician/prescriber or an authorized representative can ask for an expedited (fast) appeal if:

  • Coverage for a medical service or Part D prescription drug was denied and your health requires a quick response, or
  • You think that your covered services in a skilled nursing facility, home health or comprehensive outpatient rehabilitation facility is ending too soon

You may request an appeal by calling Customer Service toll free at:

Zing Health: 1-866-946-4458 TTY 711

You can call us 8 a.m. to 8 p.m. seven days a week (except Thanksgiving and Christmas) from October 1 – March 31 and 8 a.m. to 8 p.m. Monday – Friday (other technologies such as voicemail are used after hours, weekends, and on Federal Holidays) from April 1 – September 30.

Customer Service also has free language interpreter services available for non-English speakers.

You may also send your request in writing to:

Appeal Requests for Medical Care

Zing Health
Appeals and Grievances Department
PO Box 6589
Chicago, IL 60606

Fax: 1-844-946-4468

Email: appeals@myzinghealth.com

Appeal Requests for Part D Prescription Drugs

Zing Choice IL (HMO)
PO Box 1039
Appleton, WI, 54912-1039

Fax: 1-844-268-9791

Email: customerservice@myzinghealth.com

You may submit your Part D prescription drug appeal request electronically here:

Making a Complaint about your Medical Care or Part D Prescription Drugs

You can make a complaint about us or one of our network providers, including a complaint about the quality of your care. This is referred to as a grievance. This type of complaint does not involve coverage or payment disputes. If your problem is about the plan’s coverage or payment, you should look at the section above about if you disagree with our coverage decision.

You can file a grievance if you have a complaint about the quality of care you receive, the timeliness of services or any other concern except for the coverage or payment issues listed above. If you have coverage issues related to medical or pharmacy services, or if you or your appointed representative wishes to file a grievance, please contact Customer Service.

You may file an expedited grievance if you disagree with our decision not to expedite your request for a coverage decision or appeal, or, for medical requests, the decision to extend the timeframe for making a coverage decision.

You may also contact Zing Health if you want information about the number of appeals, grievances, or exceptions filed with the plan.

When should I use the grievance process?

These issues may be reasons to file a grievance.

  • Problems with the customer service you get from Zing Health.
  • Problems with how long you wait on the phone
  • Problems with how long you wait in the pharmacy or medical office.
  • Disrespectful or rude behavior by health plan staff, pharmacists or medical offices in our network.
  • Cleanliness or condition of pharmacy or medical office.
  • You believe our notices and other written materials are hard to understand.
  • You feel that you’re being encouraged to leave (disenroll from) our plan.
  • Failure to give you a decision within the required timeframe.
  • Failure to forward your case for an independent review if we don’t give you a decision within the required timeframe.
  • Failure by Zing Health to provide required notices.
  • Failure to provide required notices that comply with CMS standards.

Resolving Your Concerns

You must file a grievance with us no later than 60 days after the event or incident in question.

You may file an expedited grievance if you disagree with our decision not to expedite your request for a coverage decision or appeal, or, for medical requests, the decision to extend the timeframe for making a coverage decision.

By Telephone:

If you have a grievance, we ask you to first call customer service at 1-866-946-4458(TTY: 711).

We try to resolve any complaint you have over the phone. If Customer Service cannot resolve your concern over the phone, we have a formal process to review your complaints. We have made this process easy to follow so you will get a timely response. If your concern is not resolved at the time of your first phone call, it will be sent on to a grievance coordinator to be resolved.

Generally, you will be given a response to your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after we receive it, or within 24 hours for an expedited grievance. We may add to the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for more information and the delay is in your best interest. When we add to the deadline, we will immediately let you know the reason(s) for the delay in writing.

If your grievance involves the quality of the care you received, you will get a written response.

By Mail or Fax:

You may file a grievance in writing by sending a letter or fax telling us about your grievance:

Complaints about Medical Care

Zing Health
Appeals and Grievances Department
PO Box 6589
Chicago, IL 60606

Fax: 1-844-946-4468

Complaints about Part D Prescription Drugs

Zing Choice IL (HMO)
Grievance Department
PO Box 1039
Appleton, WI, 54912-1039

Fax: 1-844-268-9791

Medicare Contact Information

You can contact Medicare for more information about benefits and services, including general information about Medicare Advantage Prescription Drug coverage.

Telephone

1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week If you are hearing or speech impaired, please call 1-877-486-2048.
Online

www.medicare.gov

If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form or contact the Office of the Medicare Ombudsman

Due to COVID-19, Zing Health now offers two
new benefits for members:

1. Mail Order pharmacy service. To sign up, call 1-866-946-4458 (TTY: 711) or click here

2. MDLive Virtual Healthcare click here