Submit a claim
How and where to send us your request for payment
Send your request for payment, along with your receipt documenting the payment you have made. It’s a good idea to make a copy of your receipts for your records.
To make sure you are providing all the information we need to make a decision, you can fill out our claim form to make your request for payment.
- You don’t have to use the form, but it will help us process the information faster.
- Either download a copy of the form or call 1-844-232-2330 (TTY: 711), 24 hours a day, 7 days a week and ask for the form to be mailed to you or to ask for assistance in filling out the form.
Mail your request for payment together with any receipts to this address:
P.O. Box 52066
Phoenix, Arizona 85072-2066
Information about our process
When we receive your request for payment, we will let you know if we need any additional information from you. Otherwise, we will consider your request and make a coverage decision.
- If we decide that the drug is covered, and you followed all the rules for getting the drug, we will pay for our share of the cost. We will mail your reimbursement of our share of the cost to you. (Additional details are in Chapter 3 of the Evidence of Coverage. This explains the rules you need to follow for getting your Part D prescription drugs covered.)
- We will send payment within 30 days after your request was received.
- If we decide that the drug is not covered, or you did not follow all the rules, we will not pay for our share of the cost. Instead, we will send you a letter that explains the reasons why we are not sending the payment you have requested, and we will explain your rights to appeal that decision.
The coverage determination process includes determining requests to pay for our share of the costs of a drug that you have received. For more information on situations in which you may need to ask the plan for reimbursement or to pay a bill you have received from a provider, see Chapter 5 of your Evidence of Coverage titled, "Asking us to pay our share of the costs for covered drugs."
Please note: If you send us a payment request and we deny any part of your request, you can appeal our decision. See Chapter 7 of your Evidence of Coverage, titled, "What to do if you have a problem or complaint (coverage decisions, appeals, complaints)," for more information.
If you think we have made a mistake in turning down your request for payment or you don’t agree with the amount we are paying, you can make an appeal. If you make an appeal, it means you are asking us to change the decision we made when we turned down your request for payment. The appeals process is a formal process with detailed procedures and important deadlines.