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

Medicare’s Blue Button can help

The Blue Button 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.

At risk for diabetes? Take this test.

Diabetes affects millions of people – are you one of them? Tuesday, March 25 is American Diabetes Association Alert Day – a great time to take the Diabetes Risk Test to find out if you’re at risk for developing type 2 diabetes – a condition characterized by high blood glucose levels caused by either a lack of insulin or the body’s inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults. Many people with diabetes don’t know that they have it, but Medicare covers screening tests so you can find out if you do. 

If you have diabetes, Medicare covers many of your supplies, including test strips, monitors, and control solutions. In some cases, Medicare also covers therapeutic shoes if you have diabetic foot problems. You pay 20% of the Medicare-approved amount for these supplies.

Medicare also covers diabetes self-management training to help you learn how to better manage your diabetes. You can learn how to monitor your blood sugar, control your diet, exercise, and manage your prescriptions. Talk to your doctor about how this training can help you stay healthy and avoid serious complications.

Take control of your health – talk to your doctor today about screening tests and what supplies and training you may need for your health.

This spring, put prevention into practice

The start of spring is a reminder of new beginnings – the longer hours of daylight, sprouting tulips and warmer weather are all indicators of a new season, and a new reason to be proactive with your health. One simple way to manage your health is to practice preventive care. Because preventive services can find health problems early, when treatment works best, it’s a crucial step in maintaining a healthy lifestyle.

Your preventive services with Medicare

If you have Medicare, then you have access to a variety of preventive tests and screenings, most at no cost to you. If you’re new to Medicare, your “Welcome to Medicare” preventive visit is now covered for free during your first 12 months of Part B coverage. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed.

If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. In addition to these important wellness visits, Medicare covers screening tests for diabetes, colon cancer, breast cancer, osteoporosis and heart disease, just to name a few.

So as you tend to your garden this spring, make a commitment to tend to yourself too. Practice preventive care so you can you stay healthy, live longer, and delay or prevent many diseases.

 

Join the fight against Medicare fraud

Medicare fraud affects everyone. You can team up with Medicare to help.

Our Senior Medicare Patrol volunteers are teaching people like you how to spot, report, and stop fraud, and protect themselves from identity theft.

Here are some things you can do:

  • Guard your Medicare and Social Security Numbers. Treat them like you would treat your credit cards.
  • Hang up the phone if someone calls and asks for your Medicare number, Social Security Number, or bank or credit card information. We will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
  • Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it!
  • Do not let anyone borrow or pay you to use your Medicare ID card or your identity.
  • Check your Medicare claims for errors. Look at your Medicare Summary Notice (MSN) or statements from your Medicare plan. You can also check MyMedicare.gov, or call 1-800-MEDICARE (1-800-633-4227) as soon as your claims have been processed. The sooner you see and report errors, the sooner we can stop fraud. TTY users should call 1-877-486-2048.
  • Call 1-800-MEDICARE to report any suspected fraud.

Learn more about spotting and reporting fraud, and get tips on protecting yourself from identity theft.

Find out about Senior Medicare Patrol activities in your area.

Get help with your health care costs

You may qualify for help with your premiums, deductibles, copayments, or prescription costs with Extra Help or with a Medicare Savings Program.

Medicare has 4 savings programs that may help with your healthcare costs:

1.      Qualified Medicare Beneficiary (QMB) Program

2.      Specified Low-Income Medicare Beneficiary (SLMB)

3.      Qualified Individual (QI) Program

4.      Qualified Disabled and Working Individuals (QDWI)

If you have limited income and resources, you may also qualify for Extra Help to help pay your Medicare prescription drug costs, like premiums, deductibles, and copayments.

Find out if you qualify for a Medicare Savings Program in 2014. You can apply online or visit your local State Health Insurance Program.

This Valentine’s Day Give Your Heart Some Love

Although popular love songs might tell you otherwise, a broken heart can’t kill you – but heart disease can.  Heart disease is the leading cause of death in the United States. 

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and prevent heart disease.  Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease. 

Medicare will cover a cardiovascular screening at no cost to you every 5 years.  The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels. 

If you and your doctor discover that you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions.  You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

Luckily, you don’t have to face these challenges alone. The national Million Hearts campaign has pledged to help prevent 1 million heart attacks and strokes by 2017. You can join them, and get information and resources you need to learn how to take care of your heart and live a healthy life.

February is American Heart Month, and a healthy heart is the best Valentine’s Day gift you could ever give yourself, or the people who love you.

PROTECT YOURSELF – GET SCREENED FOR CERVICAL CANCER

Cervical cancer and human papilloma virus (HPV) affect thousands of women each year. Regular screening tests like pap tests and pelvic exams can help find cancer and other health problems early and improve recovery and survival rates. Talk to your doctor about scheduling your next test!

Find out more about Medicare’s pap test and pelvic exam coverage.

For more information about HPV, check out the American Cancer Society’s HPV Frequently Asked Questions.

To learn more about Cervical Cancer, go to the American Cancer Society’s Web site for Cervical Cancer Information.