What if...?

Real situations that come up beyond a straightforward denial — pick yours for exactly what to do.

• Your drug plan didn't answer by its own deadline
• The Independent Review Entity is overdue
• Your case is below the dollar amount required for the next level
• This is where a human often helps
• You missed a filing deadline
• You have both Medicare and Medicaid
• A quality-of-care problem, not a coverage denial
• A complaint about the plan's conduct
• This drug can't be covered by Part D at all
• You may be owed a temporary transition supply
• The prescriber's office hasn't sent the supporting statement
• You need the medication before an appeal can be decided