2. What is a grievance? Posted on September 11, 2017 at 12:34 pm.Written by advantage_admin Grievance: A type of complaint you can file regarding us or one of our participating health care providers or pharmacies, including complaints regarding quality of care. Grievances do not include coverage or payment disputes. 3. What is an appeal? Posted on September 11, 2017 at 12:34 pm.Written by advantage_admin Appeal: The action you take if you do not agree with our determination to deny coverage or a payment request for health care services or prescription drugs. You may also file an appeal if you do not agree with our determination to cease the services you are receiving. For example, you may file an appeal if we refuse to pay for a prescription drug, item, or service you understand you should receive. 2. How do I file an appeal? Posted on September 11, 2017 at 12:33 pm.Written by advantage_admin You may print out the following forms to send the information: You may call 1-888-620-1919 to file an appeal, from Monday thru Sunday, from 8:00 am to 8:00 pm. TTY/TDD users may call 1-866-620-2520. You may also: send an email to *protected email* send a fax to (787) 993-3261. mail your appeals to: Triple-S Advantage Department of Grievances and Appeals PO Box 11320 San Juan, PR 00922 1. How do I file a grievance with Medicare? Posted on September 11, 2017 at 12:30 pm.Written by advantage_admin You may give us feedback about your Medicare health care or prescription drug plan. This information will help the Centers for Medicare & Medicaid Services continuously improve the Medicare program. Medicare 1. How do I file a grievance with my Triple-S Advantage plan? Posted on September 11, 2017 at 12:25 pm.Written by advantage_admin You may call 1-888-620-1919 from Monday thru Sunday, 8:00 am to 8:00 pm. TTY/TDD users may call 1-866-620-2520. You may also: send an email to *protected email* send a fax to (787) 993-3261 mail your grievance to: Triple-S Advantage Department of Grievances and Appeals PO Box 11320 San Juan, PR 00922 3. What should I do if my physician is not in the Triple-S Advantage healthcare provider network? Posted on September 11, 2017 at 12:22 pm.Written by advantage_admin As a general rule, if a physician does not belong to your plan network, his/her service would NOT be covered. However, at Triple-S Advantage we have a wide variety of coverages to meet your needs, with available alternatives for such scenarios, such as PPOs and HMO-POS. 2. Which Advantage plan should I choose? Posted on September 11, 2017 at 12:19 pm.Written by advantage_admin At Triple-S Advantage, we have designed a rapid-response tool to help you find a plan that will meet your health conditions and/or needs. Click here. 1. What is Triple-S Advantage? Posted on September 11, 2017 at 12:15 pm.Written by advantage_admin It is a Medicare Advantage Plan provided under contract with Medicare and the Health Insurance Plan from the government of Puerto Rico (Medicaid). It provides 100% Medicare coverage, but it extends the Original Medicare benefits and provides coverage for areas not covered by Medicare. « 1 2 3