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 or an appeal?
A complaint is different than an appeal. A complaint is about the way your Medicare health plan or Medicare drug plan is giving care. Examples of complaints are problems with:
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 help. You can also call your State Health Insurance Assistance Program (SHIP) for free, personalized help filing a complaint.
If you’ve contacted 1-800-MEDICARE but still need help, ask the 1-800-MEDICARE representative to send your inquiry or complaint to the Medicare Ombudsman’s Office. The Medicare Beneficiary Ombudsman helps you with Medicare-related complaints, grievances, and information requests.
In addition to basic information like your name and address, have your Medicare card and health plan card (if you have one) readily available when you’re ready to file your complaint. And, in the future, you can also use Medicare’s Blue Button to help. It provides you an easy way to download your personal health information to a file on your own personal computer. Check out the Blue Button through your account on MyMedicare.gov.
Will a silent disease shatter your life? Every year, a growing number of Americans are finding out that they have osteoporosis—a disease that causes bones to weaken and be more likely to break. You may not know that you have this “silent” disease until your bones are so weak that a sudden strain, bump, or fall causes your wrist to break or your hip to fracture.
Medicare can help you prevent or detect osteoporosis at an early stage, when treatment works best. Talk to your doctor about getting a bone mass measurement—if you’re at risk, Medicare covers this test once every 24 months (more often if medically necessary) when your doctor or other qualified provider orders it.
May is National Osteoporosis Awareness and Prevention Month. Learn more about what puts you at risk for osteoporosis and how to prevent and treat it at the National Osteoporosis Foundation. Watch our short video to learn more about how Medicare can help you protect your bones.
Did you know that by the year 2020, more than 55 million U.S. adults will be over the age of 65? Older adults are a vital part of our society. Since 1963, communities across the country have shown their gratitude by celebrating Older Americans Month each May. This year, in honor of the 50th anniversary of the Older Americans Act, we’re focusing on how older adults are taking charge of their health, getting engaged in their communities, and making a positive impact in the lives of others.
Medicare helps older adults “Get into the Act” and promotes healthy living by offering vital preventive services like mammograms, diabetes screening, and colorectal cancer screenings. If you’ve had Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors.
Staying active, engaged, and healthy is good advice for everyone, but it’s especially important for older people. So don’t waste any time – get into the act and take charge of your health!
Are you the kind of shopper who reads reviews or looks at ratings before you make a purchase? Wouldn’t it be helpful to have the same kind of ratings when choosing a hospital?
Choosing a hospital can be overwhelming. Hospitals differ in the safety and quality of care they provide. That’s why we’ve made it easier to use the information on our Hospital Compare site by adding star ratings for patients’ experience of care.
Compare websites are a valuable source of information about the quality of health care providers and facilities. The Hospital Compare star ratings we’ve just added to the website relate to patients’ experience of care at more than 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measures that are included on Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
- How well nurses and doctors communicated with patients
- How responsive hospital staff were to patient needs
- How clean and quiet hospital environments were
- How well patients were prepared when they were discharged from the hospital
Sharing patients’ experience of care through star ratings is just one example of how we’re committed to helping you make health care decisions based upon available information. We’re working on adding an overall hospital star rating in 2016 to include the full range of quality measures reported on Hospital Compare.
Our Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one with quality in mind. Physician Compare has started to include star ratings in certain situations for physician large group practices, and we just added star ratings to our Dialysis Facility Compare site to help to make data on dialysis centers easier to understand and use. We’re planning to add star ratings to Home Health Compare later this year.
Did you know that 9% of elderly people with Medicare drink more than 30 drinks a month? The National Institute on Alcohol Abuse and Alcoholism defines “risky drinking” as more than 14 drinks per month for men, and 7 drinks per month for women.
There are lots of changes that happen with age, and some of them, like physical pain, loss of mobility, and loneliness can lead to alcohol misuse. Drinking too much alcohol increases your risk of injuries, violence, drowning, liver disease, bad interactions with medications, and some types of cancer.
If you think you could be misusing alcohol, don’t be ashamed to ask for help. April is Alcohol Awareness Month, and it’s the perfect time to remind you that Medicare covers alcohol misuse screening & counseling to provide counseling for people who misuse alcohol.
Diabetes affects millions of people – are you one of them? Tuesday, March 24 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 insulin, test strips, monitors, lancets 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.
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. Preventive services can find health problems early, when treatment works best, so taking advantage of them is a crucial step in maintaining a healthy lifestyle.
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, we cover a “Welcome to Medicare” preventive visit 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, heart disease, and obesity management, just to name a few. Check out our complete list of Medicare-covered preventive services.
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.