Annual Appeals for Prescription Coverage

[Guest SSS909]

Every year my mother reaches the limit of her prescription drug coverage. The costs above what is covered in the plan, are denied. She does file an appeal (hoping that someone might change their mind) each year. This year a plan rep says her appeal won't be reviewed since its the same issue that was denied last year. I say it is a new claim for this year and that she should go ahead and file an appeal.

I'm searching cases right now to support the above, but it seems as though I'm just spinning my wheels. Does anyone have any experience with situations like this and can point me in the right direction?

[JanetM]

If she sends an appeal in, in the proper form for the plan, the plan is required to respond. They can't just not review it.