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:
- A doctor, hospital, or provider
- Your health or drug plan
- Quality of your care
- Your dialysis or kidney transplant care
- Durable medical equipment
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.