MA-PD: Prior authorizations, exceptions, appeals and grievances (2013)
How to appoint a representative
If you want to name someone (such as a relative, friend, advocate, doctor, lawyer, or anyone else) to handle appeals and grievances with us on your behalf, the person you name would be your appointed representative. You can use this form:
Appointment of representation form
If you want to give someone permission to access your personal health information (for example claims, medical, or financial information) please use this form:
Authorization to disclose your Protected Health Information (PHI) form
Please send your completed form(s) to us at:
Health First Health Plans
6450 US Highway 1
Rockledge, Florida, 32955
For questions or more information on appointing a representative, contact Health First Health Plans Customer Service.
Health First Health Plans wants to make sure you get the care you need, and you understand how to get care under special circumstances.
Notice of privacy practices
Also, the Evidence of Coverage (EOC) includes more details about grievances, coverage determinations, appeals procedures, and exceptions in Chapter 9, and your rights and responsibilities upon diserollment are listed in Chapter 8.
Value Evidence of Coverage (Español)
Classic Evidence of Coverage (Español)
Rewards Evidence of Coverage (Español)
Platinum Evidence of Coverage (Español)
Group POS Evidence of Coverage (Español coming soon)
Group Plus A Evidence of Coverage (Español coming soon)
Group Plus B Evidence of Coverage (Español coming soon)
Group Basic A Evidence of Coverage (Español coming soon)
Y0089_MP3188 CMS Approved 12072012
Last updated: 11/2/2012