FirstMedicare Direct  


Coverage Determinations, Exceptions, Appeals & Grievances

A coverage determination is a decision by FirstMedicare Direct regarding your coverage and benefits for Medicare Part D covered prescription drugs.  This can be regarding the necessity of a drug request or about the amount you have to pay.  

An exception is a coverage determination where you ask us to waive usual coverage rules.

A redetermination (or appeal) is a formal request to have us review and change a coverage determination.

A grievance is a formal complaint that can involve any aspect of the operations, activities or behavior of FirstMedicare Direct.

The following document links contain detailed information on how to file a coverage determination, a grievance/complaint or a redetermination/ appeal.  Forms for filing requests for coverage determinations and appeals are available below.

Contact Information for Coverage Determinations, Exceptions, Appeals and Grievances for Part D Prescription Drugs

CALL 1-844-201-4957 OR TTY 711 Calls to these numbers are free. We are available for phone calls 24 hours a day, 7 days a week. Member Services also has free language interpreter services available for non-English speakers.

FAX 1-858-790-6060


MedImpact Health Systems, Inc.
10181 Scripps Gateway Ct.
San Diego, CA 92131

Grievances about Part D Prescription Drugs also made be made at

FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a Medicare contract. Enrollment in a FirstMedicare Direct plan depends on contract renewal.This is a required statement by CMS. FirstCarolinaCare has filed and been approved to offer an HMO and a PPO Medicare Advantage Prescription Drug plan for 2020.


Page Last Updated:
Friday, October 2, 2020 11:13:03 AM