How do I file a grievance with Virginia Premier?
Please call us at 1-877-739-1370 (TTY: 711). A grievance is a complaint and does not involve a request for payment, a request for authorization for services or a request for an appeal of denied services by Virginia Premier. For example, you would file a grievance if:
How do I file a complaint against a Medicare provider?
Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care you got from a Medicare provider. Like being given the wrong drug or being given drugs that interact in a negative way.
How do I file a complaint with the Virginia Department of Health?
DHP Home> Practitioner Resources> Enforcement> File a Complaint File a Complaint The Department of Health Professions receives complaints about Virginia healthcare practitioners who may have violated a regulation or law. Complaints for all the licensing and regulatory Boards are received and investigated by the agency's Enforcement Division.
How do I make an appointment of representative for Medicare?
You can download an Appointment of Representative form, call Member Services and ask for one, or visit the Medicare website. The form will give the person permission to act for you. You must give us a copy of the signed form.
What is the Medicare deductible for 2020?
In 2020, the Medicare Part B deductible is $198 per year.
What was the Medicare deductible for 2019?
In 2019, the Medicare Part B deductible is $185 per year.
What counts toward the Medicare Part B deductible?
Basically, any service or item that is covered by Part B counts toward your Part B deductible.
What happens once you reach the deductible?
Once you meet the required Medicare Part B deductible, you will typically be charged a 20 percent coinsurance for all Part B-covered services and i...
Is there a way to avoid paying the Medicare Part B deductible?
There are two ways you may be able to avoid having to pay the Medicare Part B deductible: Medicare Supplement Insurance or a Medicare Advantage plan.
Complaints about the quality of your care
Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care you got from a Medicare provider.
note
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:
How to file a complaint with Medicare Advantage?
If you have a complaint about your Medicare Advantage (Medicare Part C) plan or Medicare Part D prescription drug plan, contact your plan carrier directly or follow the plan’s instructions for filing a complaint located in your plan’s membership materials .
How to contact Medicare Help?
Your local SHIP can help with filing a Medicare complaint. To contact your state health insurance assistance program, visit this page and then select “Find Local Medicare Help” in the upper right-hand corner.
What is Medicare appeal?
A Medicare appeal concerns an issue with Medicare’s refusal to cover a specific service, device, supply or prescription. You might file a Medicare appeal if you need a certain treatment that Medicare doesn’t typically cover, but you think Medicare should cover it. Filing an appeal doesn’t guarantee that Medicare will cover your treatment or item.
How long does it take for a supplier to respond to a complaint?
They then must send you the result of their investigation and response in writing within 14 days.
How to contact the state survey agency?
To contact your State Survey Agency, call the phone number associated with your state.
Can a beneficiary file a complaint with Medicare?
A beneficiary might file a Medicare complaint over any of the above issues, such as receiving an erroneous bill from a doctor’s office, or for other related situations.
How long does it take to file a complaint with Medicare?
To file a complaint about your Medicare prescription drug plan: You must file it within 60 days from the date of the event that led to the complaint. You can file it with the plan over the phone or in writing. You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
What are some examples of complaints about a 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. Access to specialists: For example, you don't think there are enough specialists in the plan to meet your needs.
How long do you have to notify a health insurance company of a decision?
You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
Where to file a grievance in VA?
You can submit a written request to the following address: Virginia Premier Attn: Grievance & Appeals PO Box 5244 Richmond, VA 23220. Or by faxing a written request to: 800-289-4970.
Who can request a coverage determination?
A member, member representative or prescribing physician can request to initiate a coverage determination. You can request it by either:
How to appeal Medicare decision?
Also, someone besides your doctor or another provider can make the appeal for you, but first you must complete an Appointment of Representative form. The form gives the other person permission to act for you. You can download an Appointment of Representative form, call Member Services and ask for one, or visit the Medicare website. The form will give the person permission to act for you. You must give us a copy of the signed form. If the appeal comes from someone besides you or your doctor or another provider, we must receive the completed Appointment of Representative form before we can review the appeal. How much time do I have to make an appeal? You must ask for an appeal within 60 calendar days from the date of the letter we sent to tell you our decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal. Examples of a good reason are: you had a serious illness, or we gave you the wrong information about the deadline for requesting an appeal. Can my doctor give you more information about my appeal? Yes, you and your doctor may give us more information to support your appeal. When will I hear about a “standard” appeal decision? If your appeal is about:
How to get a fast decision on a health insurance plan?
If you request a fast coverage decision, start by calling, writing, or faxing our plan to ask us to cover the care you want. You can call us at 1-877-739-1370 (TTY: 711). You can also have your doctor or your representative call us. You must meet the following two requirements to get a fast coverage decision:
What are the requirements to get a fast coverage decision?
You must meet the following two requirements to get a fast coverage decision: If you are asking for coverage for medical care or an item you have not yet received. (You cannot get a fast coverage decision if your request is about payment for medical care or an item you have already received.)
What is a coverage decision?
A coverage decision is an initial decision we make about your benefits and coverage or about the amount we will pay for your medical services, items, or Part B drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay. If you or your doctor are not sure if a service, item, ...
What to do if Part D is denied?
If your coverage determination is denied for your Part D drug, you may request a redetermination. Visit your plan’s Evidence of Coverage for more information.
How to force a company to pay a claim outside the terms of the policy?
Force a company to pay a claim outside the terms of the policy provisions. Review medical records and make determinations regarding claims. Act as your legal representative or get involved in a pending lawsuit. Get involved if you have an attorney without your attorney's written permission.
What is an ethics and fairness complaint?
Ethics and Fairness Complaint Form (Provider complaints involving the participating health care provider’s contract with an insurance carrier. The issue must not be an individual controversy.)