Get the free Use this form to submit your redetermination request

Request for Redetermination of Medicare Prescription Drug Denial Because we Phoenix Health Plans denied your request for coverage of (or payment for) a prescription drug, you have the right to ask

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What is use this form to?

This form is used to report information to the IRS for tax purposes.

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Information such as income, expenses, deductions, and credits must be reported on this form.

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