Making complaints less complex

We hope every healthcare experience you have is a positive one. That’s why we offer you a variety of tools to express your concerns. One of those tools is the ability to file a complaint (sometimes called a “grievance”).

Do you have a complaint?

If you have a concern or a problem that isn’t a request for coverage or reimbursement, you have the right to file a complaint. Not sure if you need to file a complaint or an appeal? Read some examples of situations where you might need to file a complaint.

Things to know before you file a complaint:

Each plan has specific rules you’ll need to know and follow when filing a complaint.  If, after filing a complaint, your plan doesn’t address the issue, call 1-800-MEDICARE for assistance. You can also call your State Health Insurance Assistance Program (SHIP) for free, personalized help filing a complaint.

Information you’ll need to have ready when you file a complaint: 

Basic information about you 

  • First and last name
  • Date of birth
  • State you live in
  • Zip code
  • Email address
  • Preferred call back time, phone number, and response language

Medicare card information 

  • Medicare number
  • Effective date

Health or drug plan information

  • Your health or drug plan name
  • Your health or drug plan contract ID

Complaint topic

  • Benefits
  • Prescription drugs
  • Services
  • Something else

 

2 tools Medicare offers that can help…

1. A Personal Health Record (PHR) is a record with information about your health that you, or someone helping you, can keep for easy reference using a computer. You control the health information in your PHR and can get to it anywhere, at any time, with Internet access.

2. The Blue Button tool provides you an easy way to download your personal health information to a file. You can download the file of your personal data and save the file on your own personal computer.  You can access the Blue Button through your account on MyMedicare.gov.