While the advantages and opportunities available through Medicare are vast and beneficial, there can always be a few occasions where questions, concerns and qualms may arise. Luckily, Medicare is always interested in providing users with the simplest and easiest ways to satisfy any inquiries. If you are experiencing any dissatisfaction with your Medicare experience, here are a few ways to help correct the problem and get you back with the health care options that you deserve.
Filing a grievance
Whenever you are faced with any strain regarding your current Medicare plan, filing a grievance is the proper procedure to try and amend the scenario. Grievances tend to deal more with the customer satisfaction realm of Medicare, and all complaints should be directed toward contacting your local Medicare Quality Improvement Organization. Areas in which filing a grievance is an appropriate mean of action can include:
- being provided with the wrong medication.
- taking a prescription that negatively affects you.
- getting discharged from the hospital too soon.
- not receiving proper instructions for treatment or medication use.
- receiving inefficient treatment.
Once a claim has been filed, you can track its status either online or in person using the Medicare Summary Notice you receive in the mail. It is also important to note that claims need to be filed within 60 days of the specific incident you are inquiring about. So if you received inaccurate medication on January 1, 2014, you need to file the grievance before March 1, 2014.
Filing an appeal
Attempting to appeal an issue regarding Medicare's services is a separate entity from filing a grievance. The main differences between the two are primarily a financial matter, more often than not pertaining to an opposition with a payment plan or monthly premium. A few particular reasons one would file an appeal include:
- Requesting a health care service, medical supply or prescription medication that you are not receiving coverage for and feel obligated to get
- Receiving a request for a payment that you have already paid for
- Seeking to adjust the amount you are currently paying for coverage
It is important to discuss any subjects of inquiry with your doctor, health care provider or insurance agent before filing an appeal. After the initial filing, your appeal will process through five levels, with each one providing you with instructions on how to continue through the appealing procedure if you are choosing to continue. The five different levels include:
- Redetermination by the company who handles claims for Medicare
- Reconsideration by a qualified independent contractor
- Hearing before an administrative law judge
- Review by Medicare appeals council
- Judicial review by a federal district court
Receiving assistance in filing an appeal
Because of the rare nature of this occurrence, finding help to guide you through the appeal process is always available. For starters, you can always contact your State Health Insurance Assistance Program for suggested guidance, or you can fill out an "appointment of representation" form where you can select anyone from a friend, family member to personal doctor to act on your behalf.
