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  • Dental Claim Form

    You can ask us to recheck a decision made about your health plan or prescription drug coverage for services or benefits you’ve received.

  • Request For Insurance Commissioner External Review

    You can ask to have an independent review organization look over your appeal if you think we made a mistake.

  • Coverage Determination Request

    Fill out this form if you have Medicare Part D and want to know if HMSA will cover a prescription drug and how much it will cost you.

  • Dental Appeals

    You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you’ve received.

  • Medicare Member Appeals

    You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you’ve received.

  • Organization Determination (Request for Prior Authorization)

    Some services and medical care require a coverage decision by HMSA before they can be covered.

  • Member Appeals

    You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you’ve received.