Use the Medicare Complaint Form or follow the instructions in your plan membership materials to submit a complaint about your Medicare health or prescription drug plan. Complaints about your health or drug plan could include: Customer service: For example, you think the customer service hours for your plan should be different.
Full Answer
How do I file a complaint about my Medicare health plan?
Complete this form to file a complaint about your Medicare health or drug plan. Do you need help with your complaint within 10 days? Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 1-800-MEDICARE is available 24 hours a day, 7 days a week, except some federal holidays.
How do I file a complaint with the CMS national standards group?
You can use ASETT to file a complaint with the CMS National Standards Group (NSG) about alleged violations of the HIPAA Administrative Simplification requirements. Follow the steps in this infographic to file a complaint. Find out what happens when NSG receives a complaint.
What is a complaint about a health plan?
A complaint is about the quality of care you got or are getting. For example, you can file a complaint if you have a problem calling the plan, or you're unhappy with how a staff person at the plan treated you.
How do I file a complaint with no surprises?
If you have a question about these rules or believe the rules aren’t being followed, contact the No Surprises Help Desk at 1-800-985-3059 from 8 am to 8 pm EST, 7 days a week, to submit your question or a complaint. Or, you can submit a complaint online, below.
What is the best way to contact Medicare?
1-800-MEDICARE (1-800-633-4227) For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.
What is considered a grievance in Medicare?
A grievance is an expression of dissatisfaction (other than an organization determination) with any aspect of the operations, activities, or behavior of a Medicare health plan, or its providers, regardless of whether remedial action is requested.
How can Medicare problems be resolved?
Your plan is the best resource to resolve plan related issues. Call 1-800-MEDICARE. Call 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.
Who do you call with questions about Medicare?
1-800-633-4227Call 1-800-MEDICARE For questions about your claims or other personal Medicare information, log into (or create) your secure Medicare account, or call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
What is the difference between a grievance and a complaint?
Complaints can cover everything from cleanliness of restrooms to job flexibility. Grievances, on the other hand, are formal complaints made by employees when they think a company or government policy, such as an anti-discrimination law, has been violated.
What does filing a grievance accomplish?
An effective grievance procedure provides employees with a mechanism to resolve issues of concern. The grievance procedure may also help employers correct issues before they become serious issues or result in litigation.
What is a Medicare ombudsman?
The Medicare Beneficiary Ombudsman helps you with complaints, grievances, and information requests about Medicare. They make sure information is available to help you: Make health care decisions that are right for you. Understand your Medicare rights and protections. Get your Medicare issues resolved.
How do I fix Medicare premium errors?
If the issue is with the hospital or a medical provider, call them and ask to speak with the person who handles insurance. They can help assist you in correcting the billing issue. Those with Original Medicare (parts A and B) can call 1-800-MEDICARE with any billing issues.
How can I improve my Medicare coverage?
Strengthening Medicare FinancingDedicating the Medicare tax on unearned income to the HI trust fund. ... Shifting spending out of the HI trust fund. ... Filling the gaps between the Medicare taxes on unearned income and earnings. ... Reducing provider payments. ... Reducing overpayments to Medicare Advantage plans.More items...•
How do I ask Medicare a question?
Visit Medicare.gov/about-us/nondiscrimination/accessibility-nondiscrimination.html, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
Can I email Medicare forms?
You can submit your form and supporting documents to us by mail or email to Medicare Enrolment Services. To help us process your request please include Medicare enrolment in the subject line. You don't need to get your supporting document certified.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
How to file an appeal with Medicare?
For questions about a specific service you got, look at your Medicare Summary Notice (MSN) or log into your secure Medicare account . You can file an appeal if you disagree with a coverage or payment decision made by one of these: 1 Medicare 2 Your Medicare health plan 3 Your Medicare drug plan
What is an improper care complaint?
Improper care or unsafe conditions. You may have a complaint about improper care (like claims of abuse to a nursing home resident) or unsafe conditions (like water damage or fire safety concerns).
Medicare Complaint Guidelines
Familiarize yourself with the specific rules that your health plan has regarding complaints. If you don’t have a copy of these rules handy, contact your plan and ask them about complaint guidelines.
How to File Your Medicare Complaint
Be sure you have basic information on hand at the time of filing your complaint. You’ll need personal info such as your name and address as well as your Medicare card and health plan card. You can use Medicare’s Blue Button initiative to download all of your pertinent information to a file on your local computer.
File a complaint (grievance)
Find out how to file a complaint (also called a "grievance") if you have a concern about the quality of care or other services you get from a Medicare provider. Contact your State Health Insurance Assistance Program (SHIP) for local, personalized Medicare counseling.
File a claim
Get information on how and when to file a claim for your Medicare bills (sometimes called "Medicare billing"). You should only need to file a claim in very rare cases.
Check the status of a claim
Check your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan.
File an appeal
How to appeal a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan.
Your right to a fast appeal
Learn how to get a fast appeal for Medicare-covered services you get that are about to stop.
Authorization to Disclose Personal Health Information
Access a form so that someone who helps you with your Medicare can get information on your behalf.
