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Your call may be directed and answered by a licensed insurance sales agent.
TTY/TDD Users
Monday through Sunday, from 8:00 a.m. to 8.00 p.m.
For detailed information about appeals and grievances, you can call our Member Service Center or refer to Chapter 9, Section 5, 6 and 7 of your Evidence of Coverage.
For Optimo and Basic covers, refer to Chapter 7, Section 4, 5 and 9 of your Evidence of Coverage.
Send an email tomoc.e1759864300gatna1759864300vdass1759864300s@sec1759864300navei1759864300rg-sl1759864300aeppa1759864300
Call 1-888-620-1919Monday through Sunday, from 8:00 a.m. to 8:00 p.m.
TTY/TDD users should call 1-866-620-2520
Send a fax (787) 993-3261
Mail a letter to: Triple-S Advantage, Inc. Appeals and Grievances Department. PO Box 11320. San Juan, PR 00922
You may submit feedback on your health plan or Medicare drug plan. Your comments will help the Centers for Medicare and Medicaid continue improving the quality of the Medicare program.
The initial determination we make is the starting point to deal with your requests to cover a Part C medical care or service you need, or to pay for a Part C medical care or service you already received. Initial decisions about Part C medical care or services are called “organization determinations”. With this decision, we explain whether we will provide the Part C medical care or service you are requesting, or pay for the Part C medical care or service you already received.
If you are not satisfied with our coverage decision, you may file an appeal. An appeal is the formal way of requesting a review to change our initial determination for coverage or payment. You have 65 days to file an appeal for Part C items/services.
We will review the initial coverage or payment decision, and verify if the rule used to process the decision was adequate.
Your appeal will be reviewed by a reviewer different from the first one. We will complete the review and inform you about our determination.
For detailed information about appeals and grievances, you may contact our Customer Service Center, or refer to Chapter 9, Sections 5, 6, and 7 of your Evidence of Coverage. For Óptimo and Basic plans, refer to Chapter 7, Sections 4, 5, and 9 of your Evidence of Coverage.
If you would like to appoint a representative to file a grievance, to request a coverage determination or exception or request an appeal on your behalf. You and the person being appointed must fill out this form (or a written equivalent) and submit your request.
If you disagree with our decision to deny coverage or payment for drugs, you may file an appeal and stop the services you are receiving.
For example, you may file an appeal if we don’t pay for a drug or service you understand you should receive. You have 65 days to file an appeal for Part D drugs.
For detailed information about Part D drug appeals, you may call our Customer Service Center, or refer to Chapter 9, Section 6.5 of your Evidence of Coverage.
As a member of our plan, you have the right to get information from us. This includes information about the number of grievances and appeals made by members, and the plan’s performance ratings, including how it has been rated by the plan members, and how it compares with other Medicare Advantage health plans.
If you want this information, you may contact the Customer Service Department, Monday through Sunday, from 8:00 a.m. to 8:00 p.m. at 1-888-620-1919
TTY/TDD users should call 1-866-620-2520 and request the information related to grievances, appeals and exceptions filed with the plan.
To file a marketing complaint you may contact the plan at numbers provided above or by calling 1-800-MEDICARE. If possible, for this kind of complaint please provide the name of the agent or broker for whom the complaint is being filed.
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By completing this form, you agree to a meeting with a sales agent to discuss the types of products you check above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.
This selection does NOT obligate you to enroll in a plan, it does not affect your current membership, and it will not enroll you in another Medicare plan.
Monday thru Sunday, from 8:00 a.m. to 8:00 p.m.
Monday thru Friday, from 8:00 a.m. to 5:00 p.m.
Dedicated TeleConsulta for TTY/TDD Callers: 711 | 1-855-209-2639
By clicking this link, you are leaving the website of Triple-S Advantage. If you need further assistance you may contact the Member Service Center of Triple-S Advantage at 1-888-620-1919. (TTY users should call 1-866-620-2520.) Hours are Monday through Sunday from 8:00 a.m. to 8:00 p.m..
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Triple-S Advantage has a strong commitment to protecting the confidentiality of our members’ sensitive information. We take information privacy very seriously and it is important to us that our members are made fully aware of a potential privacy issue. We have learned that personal information of some of our members, including their name, health plan identification number, date of service in which treatment was provided, and treatment codes describing the service provided was mailed to the wrong address. The Social Security Numbers and date of birth of our members were NOT disclosed as a result of this incident.
On December 5, 2017, Triple-S Advantage discovered that notices sent in November 2017 to health care providers involved in the treatment of our members were mailed to the wrong address. However, we have not received any indication that the information has been accessed or used by an unauthorized individual.
Triple-S Advantage has performed an extensive investigation into why and how their personal information was disclosed. We have taken immediate steps to ensure additional notices to our members and your health care providers are sent to the correct address, such as: correction of the mailing process, completion of testings and sending the letters to the correct address of your provider. The members who may have been affected by this incident will receive first-class mail notices.
We have reported the incident to the required government agency, the Health Insurance administration of Puerto Rico (ASES) and will comply with the evaluation as required by the Office of Civil Rights within the time period established.
We are making an announcement about this incident so that affected Triple-S Advantage members can consider taking action to reduce the chances that their personal information will be misused:
If you or a family member belong to Triple-S Advantage and want additional information about the incident, you may contact our Customer Service Department from Monday through Sunday from 8:00 a.m. to 8:00 p.m. at our toll-free number 1-888-620-1919, TTY users should call 1-866-620-2520 or by e-mail at: moc.e1759864300gatna1759864300vdass1759864300s@ecn1759864300ailpm1759864300ocaap1759864300ih1759864300.
You may also visit our Internet website www.sssadvantage.com for further information.
If you are a Medicare Platino member, you can also contact the Health Insurance Administration of Puerto Rico (ASES) at or Customer and Providers Services Offices (PROBENE) at 1-800-981-2737/1-800-981-ASES from Monday through Friday 8:00 am to 4:30 pm, a Customer Services Representative will assist you. TTY users should call (787) 474- 3389. You can also contact us by email at gro.r1759864300psesa1759864300@dadi1759864300cavir1759864300pedla1759864300icifo1759864300.
Triple-S Advantage sincerely apologize and regret this situation. The privacy and security of our member’s information is very important. We are working hard to strengthen our processes for the benefit and protection of our members.
Please Note: Triple-S Advantage will NOT call or email anyone requesting any personal information as a result of this incident. If you receive an unsolicited call or email that appears to be from Triple-S Advantage, your local hospital or physician office, please do not provide any personal information in response to these calls or emails.
Triple-S Advantage, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Triple-S Advantage, Inc. cumple con las leyes federales aplicables de derechos civiles y no discrimina por razón de raza, color, origen de nacionalidad, edad, discapacidad, o sexo. Triple-S Advantage Inc. 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年 齡、殘障或性別而歧視任何人ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call: 1-888-620-1919 (TTY: 1-866-620- 2520). ATENCIÓN: Si usted habla español, servicios de asistencia lingüística están disponibles libre de cargo para usted. Llame al: 1-888-620-1919 (TTY: 1-866-620-2520). 注意:如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-620-1919 (TTY: 1-866-620-2520)。
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