Access to quality health care services is crucial for maintaining your well-being, helping prevent and manage diseases. If you’re unsatisfied with your health care, you may want to talk with the individual who performed the care. But if you don’t wish to speak with that person or need more help, you can file a Medicare complaint (aka grievance).
A complaint pertains to the quality of care you received or are receiving. For instance, you can submit a complaint if you have an issue calling the plan, or you’re unhappy with how a plan’s staff member treated you.
Meanwhile, you can file an appeal if you have a problem with a plan that’s unwilling to cover a supply, service, or prescription.
You have the right to appeal if Medicare refuses:
You’ll get a decision at each level of the appeals process. If you disagree with a decision made at any level, you can usually proceed to the next level by following the decision letter’s instructions.
How you file a complaint will depend on the issue. There is some overlap, but the main types of grievances pertain to:
If you’re signed up for a Medicare health or drug plan, each has separate rules for filing a Medicare complaint. If you still need assistance after filing a claim with your plan, call 1-800-MEDICARE (1-800-633-4227).
For other types of Medicare-related grievances, call your State Health Insurance Program (SHIP) for free assistance.
Once you file your complaint, your supplier has to:
Each year, Medicare plans change, and the premiums go up. At Trusted Senior Specialists, we assign an agent to you to make sure you’re in the right program and will be there for you year in and year out. We won’t disappear after we get you signed up. Whether you need to change your coverage, file an appeal, or file a complaint, we’re here to help.
We believe in creating everlasting relationships with our clients. Let us help get you the health care you deserve — call (844) 325-8710 or schedule a video chat through our website.