Did you know that Medicare has an ombudsman to help you resolve complaints you may have about your healthcare?<\/p>\n
Congress created the job of Medicare Beneficiary Ombudsman to assist people with Medicare with their inquiries, complaints, grievances, appeals, and requests for information.<\/p>\n
The Medicare Beneficiary Ombudsman also shares information with Congress, the Secretary of Health and Human Services, and other organizations about what works well and what doesn\u2019t work well to improve the quality of the care you get through Medicare.<\/p>\n
If you need help with a Medicare-related inquiry, there are several ways you can get help.<\/p>\n
1. Call your plan.\u00a0If your inquiry is related to your Medicare Advantage (Part C) plan or Medicare Prescription Drug (Part D) plan, contact your plan first using the phone number on your plan member ID card. Your plan is the best resource to resolve plan-related issues.<\/p>\n
2. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If your concern is related to Original Medicare, or if your plan was unable to resolve your inquiry, contact 1-800-MEDICARE for help.<\/p>\n
3. Contact the SHIP.\u00a0The State Health Insurance Assistance Programs (SHIPs) provide free, high-quality counseling to people with Medicare regarding their benefits, coverage, appeals, and complaints. SHIP counselors are volunteers who often have Medicare themselves, so they know the issues and they\u2019re not trying to sell you anything. Find your local SHIP at https:\/\/www.shiptacenter.org\/<\/p>\n
4. Contact the Medicare Beneficiary Ombudsman.\u00a0If you have been unable to resolve your concern with your plan or 1-800-MEDICARE, ask a 1-800-MEDICARE representative to submit your complaint or inquiry to the Medicare Beneficiary Ombudsman. The Ombudsman will help to ensure that your inquiry is resolved appropriately.<\/p>\n
No matter how you get your Medicare, you have certain rights and protections. As a person with Medicare, you\u2019re entitled to:<\/p>\n
\u2022 Be treated with dignity and respect at all times.
\n\u2022 Be protected from discrimination. Every company or agency that works with Medicare must obey the law. They can\u2019t treat you differently because of your race, color, national origin, disability, age, religion, or sex.
\n\u2022 Have your personal and health information kept\u00a0private.
\n\u2022 Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
\n\u2022 Get understandable information about Medicare to help you make health care decisions, including:
\n\t\u2022 What\u2019s covered;
\n\t\u2022 What Medicare pays;
\n\t\u2022 How much you have to pay;
\n\t\u2022 What to do if you want to file a\u00a0complaint\u00a0or\u00a0appeal.
\n\u2022 Have your questions about Medicare answered.
\n\u2022 Have access to doctors, specialists, and hospitals.
\n\u2022 Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions.
\n\u2022 Get healthcare services in a language you understand and in a culturally-sensitive way.
\n\u2022 Get Medicare-covered services in an emergency.
\n\u2022 Get a decision about healthcare payment, coverage of services, or prescription drug coverage.
\n\t\u2022 When a claim is filed, you get a notice letting you know what will and won\u2019t be covered. The notice comes from one of these:
\n\t\u2022 Medicare;
\n\t\u2022 A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage\u00a0Plans provide all of your Part A and Part B benefits;
\n\t\u2022 Your\u00a0Part D. Part D adds prescription drug coverage to original Medicare, some Medicare cost plans, some Medicare private-fee-for-service plans, or Medicare medical savings account plans
\n\t\u2022 Your other Medicare health plan.
\n\u2022 If you disagree with the decision on your claim, you have the right to file an appeal.
\n\t\u2022 Request a review (appeal) of certain decisions about healthcare payment, coverage of services, or prescription drug coverage.
\n\t\u2022 If you disagree with a decision about your claims or services, you have the right to appeal.
\n\t\u2022 File complaints\u00a0(sometimes called \u201cgrievances\u201d), including complaints about the quality of your care.<\/p>\n
You can find more information at:\u00a0https:\/\/www.medicare.gov\/claims-appeals\/your-medicare-rights\/get-help-with-your-rights-protections.<\/p>\n","protected":false},"excerpt":{"rendered":"
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