Member Benefits and Tools
Request an Appeal
If Jefferson Health Plans has denied coverage or payment for a prescription drug or medical service or item that you or your provider or prescriber requested, and you disagree with the decision, you have the right to appeal.
Prescription Drugs
About Appeals and Grievances
If you’re facing an issue with Jefferson Health Plans, please contact Member Relations at 1-833-422-4690 (TTY 1-877-454-8477) and we will work to resolve the issue.
If you believe that Jefferson Health Plans should pay for a service or benefit that has been denied, in whole or in part, or if you are disputing any cost sharing amounts you owe for an item or service, or a rescission of coverage decision, you have the right to appeal the decision. If you have any other type of complaint or problem with our plan, you can file a grievance.
How to Contact
1Verbal Appeal or Grievance
You can call Member Relations at 1-833-422-4690 (TTY 1-877-454-8477) to file a verbal appeal or grievance.
October 1 – March 31, we’re available 8 a.m. – 8 p.m. seven days a week
April 1 – September 30, we’re available 8 a.m. – 8 p.m. Monday through Friday
2Written Appeal or Grievance
You can send your appeal or grievance in writing to:
Attn: Member Appeals Department/CGA Unit Jefferson Health Plans
1101 Market Street, Suite 3000
Philadelphia, PA 19107
Grievances and appeals can also be faxed to 215-991-4105. If you would like to file an Expedited Appeal and it is outside of normal Member Relations hours of operation, please fax your expedited request to 215-991-4105. See appeal forms below.
Additional Resources
For Members: To appeal to Jefferson Health Plans use the internal appeal request form. To appeal to the Pennsylvania Insurance Department use the external appeal request form.
For Providers: expedited appeal request form