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How do I file a grievance?

I received a favorable decision on an appeal to my Medicare Advantage Plan to cover the cost of a doctor’s office visit. I had already paid for the cost of the visit out of pocket, and my plan notified me that I would receive a reimbursement. It has been months and I have still not received one. What should I do?

 

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Posted April 11, 2022 by at United States in Medicare
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If you are dissatisfied with your Medicare Advantage or Part D prescription drug plan for any reason, you can choose to file a grievance. A grievance is a formal complaint that you file with your plan. It is not an appeal, which is a request for your plan to cover a service or item it has denied. Times when you may wish to file a grievance include:

  • If your plan has poor customer service
  • You face administrative problems (such as the plan taking too long to file your appeal or failing to deliver a promised refund)
  • You believe the plan’s network of providers is inadequate

 
To file a grievance:

  • Send a letter to your plan’s Grievance and Appeals department. Check your plan’s website or contact them by phone for the address.
  • You can also file a grievance with your plan over the phone, but it is best to send your complaints in writing.
  • Be sure to send your grievance to your plan within 60 days of the event that led to the grievance.
  • You may also want to send a copy of the grievance to your regional Medicare office and to your representatives in Congress, if you feel they should know about the problem. Go to www.medicare.gov or call 1-800-MEDICARE to find out the address of your regional Medicare office.
  • Keep a copy of any correspondence for your records.

 
Your plan must investigate your grievance and get back to you within 30 days. If your request is urgent, your plan must get back to you within 24 hours. If you have not heard back from your plan within this time, you can check the status of your grievance by calling your plan or 1-800-MEDICARE.
 
Best of luck filing your grievance and getting your reimbursement!

Q&A content courtesy of Interactive's Dear Marci, a free e-newsletter from the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. For more free answers to your Medicare questions, visit Medicare Interactive (MI) at www.medicareinteractive.org. Subscribe to Dear Marci by registering for your free account on Medicare Interactive. 

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This information is republished with permission from the Medicare Rights Center. For more info visit www.medicarerights.org

Added: April 11, 2022