Back Grievance & Appeals


Our members are very important to Solis Health Plans. We work hard to ensure all our members are satisfied with us. However, if you do have a complaint or concern, you may file a grievance. A grievance is a complaint or dispute that expresses dissatisfaction with any aspect of the operations, activities, or behavior of a Medicare health plan, or its providers.

You may request an expedited grievance if:

  • We deny your request for an expedited organization/coverage determination.
  • We deny your request for an expedited reconsideration/Part C appeal and/or redetermination/Part D appeal.
  • You disagree with our decision to extend the timeframe to make an initial organization/coverage determination or expedited reconsideration/Part C appeal and/or redetermination/Part D appeal.


An appeal is the action you or your authorized representative can take if you disagree with a decision Solis Health Plans has made on an Organization Determination. When we have completed the review, we will provide you our decision. There are five successive levels to the appeals process:

  • Level 1: Reconsideration by the health plan.
  • Level 2: Review by the Independent Review Entity (IRE).
  • Level 3: Hearing by an Administrative Law Judge (ALJ).
  • Level 4: Review by the Medicare Appeals Council (MAC).
  • Level 5: Review by a Federal District Court.

A decision may be appealed to the next level when the lower appeal entity issues a decision that is unfavorable to the member. Each unfavorable decision letter will provide instructions on how to move to the next level of appeal. You or your authorized representative can go on to the first level of appeal by requesting Solis Health Plans to review the unfavorable coverage determination decision.

When filing a written Redetermination (Part D Appeal), please note that if your appeal relates to a decision by us to deny a drug that is not on our formulary, your prescriber must indicate that all the drugs on any tier of our formulary would not be as effective to treat your condition as the requested off-formulary drug or would harm your health. You may also contact our Member Services department to request a Redetermination Request Form or see the downloadable form below.

How To File a Grievance and/or Appeal

You or your authorized representative can file a grievance with Solis Health Plans no later than 60 days after the occurrence. You can do so by any of the following ways:

Call Solis Member Services department at 1-844-447-6547, TTY 711.
From April 1 - Sept. 30: 8 a.m. to 8 p.m. Monday - Friday
From Oct. 1 – March 31: 8 a.m. to 8 p.m., Monday – Sunday

In writing:
If you prefer, you can download a copy of the form below and send it via fax or mail:

  • Fax number:1-833-615-9263
  • Mailing address:
    Solis Health Plans, Inc.
    PO Box 524173
    Miami, FL 33152

You can also file a complaint directly on the CMS website.

Please download the Grievance and Appeals Form here

If you or your legal representative requires assistance in preparing and submitting your written Redetermination request, please contact the Solis Member Services department and a Member Services Representative will assist you.

Once the request is received by Solis Health Plans, we will decide and provide notice of our decision as quickly as your health requires, but no later than 72 hours for expedited requests, or 7 calendar days for standard requests. If the decision is unfavorable, you or your authorized representative can request further review. After the first level of appeal, all following levels of appeal will be reviewed by an entity that is contracted with the Medicare Program, or the federal court system. This will help ensure a fair and impartial decision.

To file a complaint with CMS, you can click here.

To submit a coverage determination, click here.

For the Request for Redetermination of Medicare Prescription Drug Denial Form click here.