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Grievances and Appeals


Your Right to Make Complaints

You have the right to make a complaint if you have concerns or problems related to your coverage or care. Appeals and grievances are the two different types of complaints you can make.

An appeal is the type of complaint you make when you want Advantra Savings to reconsider  a decision we have made about what service or benefit is covered for you or what we will pay for a service or benefit.

A grievance is the type of complaint you make if you have any other type of problem with Advantra Savings, a provider or your medical savings account (MSA).

Refer to your Evidence of Coverage under “Appeals and Grievances” for more detailed information on how to make complaints in different situations.

If you have a complaint, we encourage you to first call Customer Service at 1 (877) 359-5331 ; TDD for the hearing impaired: 1 (866) 386-2335, Monday through Friday, 8:00 a.m. - 10:00 p.m., ET. From November 15th through March 1st, additional Saturday hours, 8:00 a.m. - 4:00 p.m. ET.

You can fax your request to 1 (800) 535-4047. We will try to resolve any complaint that you might have over the phone or you may send us your grievance and we will respond back to you as quickly as your case requires based on your health status.

If you have complaints about a denial of coverage or payment, you have the right to file an appeal within 60 calendar days after we notify you of the denial.

To file a standard appeal, you can send the appeal to us in writing to:

Advantra Savings Member Appeals and Grievance Unit
4300 Cox Road
Glen Allen, VA 23060

To file a fast appeal, you can call us at 1 (800) 752-5708 Monday - Friday 8:00 a.m. - 5:00 p.m., hearing impaired members should call our TDD number at 1 (866) 386-2335. You can fax your request to 1 (800) 535-4047.

For more detailed information, refer to your Evidence of Coverage document, “On How to Make an Appeal or Grievance.”

You also have the right to get a summary of information about the appeals and grievances that have been filed against Advantra Savings in the past. To get this information, call Customer Service at 1 (877) 359-5331; TDD for the hearing impaired: 1 (866) 386-2335 Monday through Friday, 8:00 a.m. - 10:00 p.m., ET. From November 15th through March 1st, additional Saturday hours, 8:00 a.m. - 4:00 p.m., ET.

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Your Appeal Rights

For more information about your appeal rights, call us or see your Evidence of Coverage.

There Are Two Kinds of Appeals You Can Request

Expedited (72 hours) - You can request an expedited (fast) appeal for cases that involve medical coverage determinations, if you or your doctor believes that your health could be seriously harmed by waiting up to 30 days for a decision. If your request to expedite is granted, we must make a decision no later than 72 hours after receiving your appeal.

  • If the doctor who asks for an expedited appeal for you, or supports you in asking for one and the doctor indicates that waiting for 30 days could seriously harm your health, we will automatically expedite the appeal.
  • If you ask for an expedited appeal without support from a doctor, we will decide if your health requires an expedited appeal. If you do not get an expedited appeal, your appeal will be decided within 30 days.

Standard (30 - 60 days) - You can request a standard appeal for a case that involves medical coverage or payment determinations. We must give you a decision no later than 30 days after receiving your appeal for coverage appeals or 60 days for claims payment appeals.

What Do I Include with My Appeal?
You should include your name, address, and Member ID number. You should also include the reasons for your appeal, and any evidence you wish to attach.

How Do I Request an Appeal?
For an Expedited Appeal: You or your appointed representative should contact us by telephone at 1 (866) 386-2330 or fax at 1 (866) 415-2821

For a Standard Appeal: You or your appointed representative should mail your written appeal to the address below:

Advantra Savings Member Appeals and Grievance Unit
4300 Cox Road
Glen Allen, VA 23060

You can fax your request to: 1 (800) 535-4047.

What Happens Next?
If we turn down your request we are required to send your request to an independent review organization that has a contract with the federal government and is not a part of Advantra Savings. This organization will review your request and make a decision about whether we must give you the care or payment you want.

If you are unhappy with the decision by the independent review organization that reviewed your case you can appeal to an administrative law judge (ALJ) if the value of your appeal meets a minimum dollar amount. If you disagree with the ALJ decision, you will have the right to further appeal. You will be notified of your appeal rights if this happens.

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Contact Information

If you need information or help, call us at:
1 (877) 359-5331 ; TDD for the hearing impaired: 1 (866) 386-2335, Monday through Friday, 8:00 a.m. - 10:00 p.m., ET. From November 15th through March 1st, additional Saturday hours, 8:00 a.m. - 4:00 p.m., ET.

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Other Resources To Help You

Medicare Rights Center:
Toll Free: 1-888-HMO-9050

Elder Care Locator
Toll Free: 1-800-677-1116

1-800-MEDICARE (1-800-633-4227)
TTY/TTD: 1-877-486-2048

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M0003_08MSA_152a APGRsummary
CMS Approved 09/19/2007

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Para información en español, por favor de llamar gratis al 1 (800) 474-5993 TTY/TDD: 1-888-788-4010, siete dias a la semana de 8:00 a.m. a 8:00 p.m. hora local.

We hope this website will help you understand Medicare Advantage Medical Savings Account (MSAs) including a new plan called -- Advantra Savings.

With all of the information available on the topic of Medicare health plans, it can be confusing. We have organized this website to help you easily find the information you need.

Atop every “page” of this website, you will find five “navigational bars” that organize content into simple sections to help you.

Advantra Savings Plans identifies the products available in your service area including a plan overview and features, premiums, deductibles and out-of-pocket costs. View the states and counties where Advantra Savings is available and more.

Enrollment features forms and instructions on how to enroll.

Understanding MSA explains Medicare Advantage Medical Savings Account (MSA) in a Question and Answer format.

Contact Us contains important phone numbers and addresses for prospective and existing members, providers and brokers.

About Coventry offers background information on our company, Coventry Health Care, Inc.

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