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Monday through Sunday, from 8:00 a.m. to 8.00 p.m.
As a member, you have the right to file a grievance or appeal directly with the plan or through Medicare.
We guide you on what is an appeal, a complaint and a grievance.
It is the formal process to which you are entitled as a member if we have made a coverage decision and you are not satisfied with it. Through this process, you can request a review of the determination.
It is a way to let us know that you have a complaint about some process, service, benefits of your coverage or any other situation that we can help you resolve through a phone call or in our Member Service Centers without going through a formal grievance process.
It is a formal expression of dissatisfaction with any process of the plan's operation, benefits of your coverage, services provided and your medication coverage.
Our Member Service Center is available to help you, call us!
1.888.620.1919 toll-free. 1.866.620.2520 TTY (hearing impaired) Monday to Sunday 8 a.m. to 8 p.m.
We can help you with questions about your benefits or any service you have received or are about to receive, pre-authorization status, request for durable medical equipment, justifications for your medications or treatments and more.
An appeal is the formal process to which you are entitled as a member if we have made a coverage decision and you are not satisfied with it. Through this process, you can request a review of the determination.
The plan's initial determination is the starting point for working with requests you may have regarding coverage for a medical service or care under your Medicare Advantage plan (Part C) that you need or payment for a medical service or care under Part C that you have already received. Initial decisions regarding medical care or services under Part C are called 'organization determinations'. With this decision, we explain whether we will provide the medical care or service under Part C that you requested or whether we will pay for medical care or services under Part C that you have already received.
If we make a coverage decision and you are not satisfied, you can appeal the decision. An appeal is the formal way to request that we review and change our initial coverage or payment determination. You have up to 60 calendar days to file an appeal for Part C.
We will review the initial coverage or payment decision and verify the regulation used in processing the decision and whether it was adequate.
Your appeal will be reviewed by a different reviewer than the first one. We will complete the review and inform you of the determination.
For detailed information on appeals and grievances, you can call our Member Service Center or refer to your Evidence of Coverage.
You can call our Member Service Center for help with questions about your benefits or any service you have received or are about to receive, pre-authorization status, requests for durable medical equipment, justifications for your medications or treatments, and more. You can also file your appeal during this call.
Email us at: 1760969998 1760969998 mo1760969998c.ega1760969998tnavd1760969998asss@1760969998secna1760969998veirg1760969998-slae1760969998ppa 1760969998 1760969998 1760969998 1760969998
Call 1-888-620-1919, Monday to Sunday, 8:00 a.m. to 8:00 p.m. Hearing-impaired individuals with specialized TTY/TDD equipment should call 1-866-620-2520
Fax us at (787) 993-3261
Mail us a letter to: Triple-S Advantage, Inc. Appeals and Grievances Department. PO Box 11320. San Juan, PR 00922
If a member wishes to appoint a representative to file a grievance, request a coverage determination or exception, or request an appeal on their behalf, the member and the person accepting the representation must complete the form below (or equivalent in writing) and submit their request.
Call us at 1-888-620-1919, Monday to Sunday, 8:00 a.m. to 8:00 p.m. Hearing-impaired individuals with specialized TTY equipment should call 1-866-620-2520
Or mail us a letter with your request to: Triple-S Advantage, Inc. Appeals and Grievances Department. PO Box 11320. San Juan, PR 00922
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.
Send an email to: moc.e1760969998gatna1760969998vdass1760969998s@sec1760969998navei1760969998rg-sl1760969998aeppa1760969998
Call 1-888-620-1919 Monday 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
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.
You can call our Member Service Center for help with questions about your benefits or any service you have received or are about to receive, pre-authorization status, requests for durable medical equipment, justifications for your medications or treatments, and more.
Email us at: moc.e1760969998gatna1760969998vdass1760969998s@sec1760969998navei1760969998rg-sl1760969998aeppa1760969998
To file a grievance, including marketing complaints, you can call our Member Service Center at 1-888-620-1919 toll-free, Monday to Sunday, 8 a.m. to 8 p.m. Hearing-impaired individuals with specialized TTY equipment should call 1-866-620-2520 You can also call 1-800-Medicare.
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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.
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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.e1760969998gatna1760969998vdass1760969998s@ecn1760969998ailpm1760969998ocaap1760969998ih1760969998.
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.r1760969998psesa1760969998@dadi1760969998cavir1760969998pedla1760969998icifo1760969998.
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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