How To File A Medicare Grievance

Ever have a problem getting an appointment with your Medicare doctor or feel that

you have been treated poorly by the staff? You have a right to file a grievance. In fact, all insurance organizations have a grievance procedure to ensure their members have a way of expressing their dissatisfaction.

Medicare beneficiaries need to understand their rights to quality care and services, suggests Alan Weinstock, an insurance broker at www.MedicareSupplementPlans.com. If they have a complaint or a dispute about the operations, activities or behavior of a Medicare health plan or its providers, they should file their grievance with their insurance carrier either orally or in writing within 60 days of the occurrence.

Grievance Procedures for Medicare Insurance

Medicare plans must provide grievance procedures to ensure timely hearing and resolution of both standard and expedited grievances between you and the plan carrier or service provider. Medicare grievance procedures must include:

The ability to accept information and evidence of the grievance either orally or in writing within 60 days of the occurrence, and

The requirement to respond within 24 hours to a members expedited grievance when

A Medicare health plan extends the time frame to make an organization determination or reconsideration or

A Medicare health plan refuses to grant a request for an expedited organization determination or reconsideration.

An organization determination is any decision made by a Medicare health plan regarding receipt of or payment for a managed care item or service; the amount that the health plan requires a member to pay for an item or service; or a limit on the quantity of items or services.

If a Medicare health plan denies a member's request for an item or service in whole or in part, the member may appeal the decision to the plan by requesting a standard or an expedited reconsideration.

Members must be notified of a decision regarding an organization determination or reconsideration within 72 hours for expedited requests, within 30 calendar days for standard requests or 60 calendar days for payment requests.

Know Your Medicare Grievance Rights

If you feel you have a grievance against your Medicare insurance carrier for any reason, be sure to file your complaint with them either orally or in writing.

If you are unsure about your Medicare insurance carriers grievance procedures, ask for a copy of their written grievance procedures, suggests Alan. You have a right to this information upon enrollment, involuntary disenrollment, annually and upon request.

Alan knows the importance of providing top-notch customer service. As an insurance broker at www.MedicareSupplementPlans.com, Alan and his team work with Medicare beneficiaries everyday to ensure they find the best Medicare supplement plan for their individual needs.

by: Dallas

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