As a member of an Sentara Medicare plan, we want to work with you to resolve any problems or concerns you have about our health plan, your coverage for medical services or prescription drugs, your experiences at your doctor’s office, pharmacy, hospital, or other facility, and/or the quality of the care you receive.
Important information is included here to help you with issues you may experience. You cannot be disenrolled from an Sentara Medicare plan or penalized in any way if you file a complaint, request a coverage decision or file an appeal.
If you are a member of Sentara Community Complete (HMO D-SNP) and Sentara Community Complete Select (HMO D-SNP) you have a concern about your health plan, the quality of your care or your coverage for certain services, you may follow an established process to resolve your concern. You cannot be disenrolled from our plan or penalized in any way if you make a complaint, request a coverage decision, or file an appeal.
You can file a complaint with Sentara Medicare or directly with Medicare. To learn more about filing a complaint, contact Medicare member services 1-800-927-6048 (TTY: 711), October 1 through March 31, 7 days a week, from 8 a.m. to 8 p.m. or April 1 through September 30, Monday through Friday, from 8 a.m. to 8 p.m.
Sentara Community Complete Appeals
Request a Coverage Decision
Request a standard decision for a prescription drug. The member, representative, or prescribing physician can submit this request. The request could be for a variety of reasons. Please review the forms for examples.
- Sentara Community Complete FIDE Select (HMO D-SNP) Medicare Prescription Drug Coverage Determination Request Form (CY2026) CMS Contract H4499, PBP 001
- Sentara Community Complete Select (HMO D-SNP) Medicare Prescription Drug Coverage Determination Request Form (CY2026) CMS Contract H2563, PBP 020
- Sentara Medicare Plans CY2026 Medical Necessity General PA Form
Appeal a Coverage Decision
You can use these forms to request a reconsideration (appeal) of our decision if you disagree with Sentara Medicare's decision to deny your request for coverage or payment for a Part C (medical item or service) or Part D (prescription drug) service. You can also file an appeal through Medicare.gov if you have exhausted your options through Sentara Medicare.
- Sentara Community Complete Select (HMO D-SNP) Medicare Prescription Drug Redetermination (Appeal) Request Form (CY2026) CMS Contract H2563, PBP 020
- Sentara Community Complete FIDE Select (HMO D-SNP) Medicare Prescription Redetermination (Appeal) Request Form (CY2026) CMS Contract H4499, PBP 001
Appoint a Representative
Appoint a representative who can assist you in filing a complaint, requesting a coverage decision, or filing an appeal.
Appointment of Representative form on CMS.gov
File a Complaint
Instructions for how to file a complaint with Sentara Medicare. A complaint, or grievance, can be filed when you are not satisfied with the quality of care or services you received from your in-network provider or Sentara Medicare. You can also file a complaint directly with Medicare.gov.
Complaint Form from Medicare.gov
Appeal Information from Medicare.gov
Complaint information from Medicare.gov
Who to Contact
Information about the number of Appeals, Grievances & Exceptions filed with Sentara Community Complete:
Sentara Medicare
Appeals and Grievances
PO Box 62876
Virginia Beach, VA 23466
Fax: 1-800-289-4970
TTY: VA Relay Service 1-800-828-1140 or 711