Filing a Medicare Grievance
Having access to health care is incredibly important, both to help make you better when you’re sick or hurt and to try to prevent health issues down the road. Medicare is a popular health care option for people who are eligible to enroll, but even then, things aren’t always perfect. You may love your plan, but you may have an issue with some of the health care you’ve received. If this sounds like you, you may be able to file a Medicare grievance to try and resolve your issue. What exactly is a grievance and how do you file one? Let’s find out!
What is a Medicare Grievance?
The Centers for Medicare & Medicaid Services (CMS) considers a grievance to be an expression of dissatisfaction with your Medicare plan or covered health care provider. The openness of this definition is designed to give beneficiaries the ability to have a greater say in their health care and their coverage. Some examples of groups or individuals you can file a Medicare grievance against, should you need to, could include:
- Your Medicare plan;
- A health care provider;
- A health care facility;
- Or a durable medical equipment (DME) provider.
Generally, the complaint will be about the quality of care, service, or coverage you’re receiving, ensuring you have the ability to rectify mistakes with your health care. For example, let’s say a pharmacy gives you the wrong medications. You could file a grievance to have that fixed. If you notice your plan isn’t following CMS guidelines or is sending you bad information, you can also file a grievance to get that corrected. You can even file a grievance if your plan isn’t following the appeals process correctly or you take issue with the plan not granting requests for fast appeals or fast determinations.
Medicare Grievances vs. Appeals
Now that we’ve mentioned the appeals process, you may be wondering, what’s the difference between the two? Both are used to give beneficiaries a voice in their coverage, and both are used as ways to rectify issues you have with your coverage or care. So, why are there two? You can define the difference by focusing on what the complaints are about. For Medicare appeals, the complaint is about your Medicare coverage, or more specifically, what’s not covered. Medicare grievances cover the quality of your health care and Medicare coverage.
It’s important to know the difference between the two, so should you run into issues, you know where to turn.
A practical example of this would be from our medication example above. If a pharmacy gives you the wrong medication or a medication that interacts poorly with another drug you’re taking, you’d file a Medicare grievance. If your Medicare plan doesn’t cover a specific drug that you feel it should, you’d file a Medicare appeal. It’s important to know the difference between the two, so should you run into issues, you know where to turn.
How to File a Grievance
Let’s say you do run into an issue and need to file a grievance. What’s the process to do so? First, any complaint must be filed within 60 days of the event that you have an issue with. The grievance can be filed verbally (as in a phone call) or in writing. Once the grievance has been filed, the Medicare plan must provide procedures toward a meaningful and timely resolution to all interested parties. Once the investigation has been completed, the plan must notify each party of this completion no later than 30 days after the original grievance was received.
Of course, should you need additional assistance, you can talk to your State Health Insurance Assistance Program (SHIP).
Depending on what you’re filing a complaint about, where you turn may differ. For example, if you’re having an issue with durable medical equipment (DME), you can turn to the equipment’s producer or call 1-800-MEDICARE. Quality complaints about a health care provider can be filed through the Beneficiary and Family Centered Care Quality Improvement Organization. For issues arising from End-Stage Renal Disease (ESRD) care, you can talk to ESRD Networks or State Survey Agencies. For complaints about your Medicare plan, fill out the Medicare complaint form to get started on your grievance. Of course, should you need additional assistance, you can talk to your State Health Insurance Assistance Programs (SHIP).
● ● ●
Ultimately, a Medicare grievance gives beneficiaries a powerful voice in the quality of their Medicare coverage and their health care. If you’re experiencing issues with your health care, don’t be afraid to use the tools at your disposal by filing a Medicare grievance. You deserve to have high-quality health care, and the grievance process is one way that you can protect your right to quality care.
Featured Blogs
- Learning to Ski
- The Stories Behind Classic Christmas Carols
- 4 More Tips to Make Christmas Tree Hunt Less Stressful
- Why Do We Celebrate That? Other Festive Holidays
- A Senior Guide to Boston
- A Senior Guide to Edinburgh
- How Does Medicare Cover Osteoporosis?
- What are Ulcers?
- Medicare's Coverage of Parkinson's Disease
- What is a Cognitive Screening?
- Spooky Spots for Halloween 2023
- 4 Ways to Keep Trick-or-Treating Safe
- 10 Classic Horror Books for Halloween
- Here's What Medicare Costs in 2024
- 10 Safety Rules for Seniors Who Enjoy Hunting
- Medicareful Living is Changing Its Name — Here's Why
- CMS Releases 2024 Medicare Advantage and Part D Costs
- Can You Keep Your Medicare Plan Each Year?
- A Senior Guide to Lucerne
- Is Expensive Cookware Worth It?
- The Drug Prices Medicare Can Directly Negotiate
- Does Medicare Ever Cover Cosmetic Surgery?
- A Senior Guide to Barcelona
- How Does COBRA Work with Medicare?
- Different Ways Medicare Can Cover Drug Costs
- Medicareful Living is Changing Its Name — Here's Why
- CMS Releases 2024 Medicare Advantage and Part D Costs
- Can You Keep Your Medicare Plan Each Year?
- Medicareful Travel: Senior Trip to Lucerne
- Is Expensive Cookware Worth It?
- The Drug Prices Medicare Can Directly Negotiate
- Does Medicare Ever Cover Cosmetic Surgery?
- Medicareful Travel: Senior Trip to Barcelona
- How Does COBRA Work with Medicare?
- Different Ways Medicare Can Cover Drug Costs
- All About Enrolling in Social Security
- Medicareful Travel: Senior Trip to the Madrid
- Does Medicare Cover Open-Heart Surgery?
- Exercise Tips for Summer
- Medicareful Travel: Senior Trip to Lisbon
- Hosting a Safe Summer Barbecue
- Senior Summer Barbecue Tips
- Does Medicare Cover Biopsies?
- 5 Foods to Avoid if You Have High Blood Pressure
- Medicareful Travel: Senior Trip to the Finger Lakes
- Does Medicare Cover Endoscopies?
- Ways Seniors Can Recover from a Workout
- Is Chocolate Healthy for You?
- Understanding Adult ADHD
- How Does Medicare Cover Hypertension?
- The Symptoms and Treatment of Parkinson's Disease
- How to Determine What Temperature to Use When Cooking
- Eating Healthy on a Budget
- Keeping Fit on Vacation
- Is Your Tonsillectomy Covered by Medicare?
- Tips for the Perfect Hard-Boiled Eggs
- Kitchen First Aid Tips
- What Does FDA-Approved Mean?
- Medicareful Travel: Senior Guide to New York City
- How to Caramelize Onions
- Why Do We Celebrate That? April Fools’ Day
- Medicare and Powers of Attorney
- The Essential Role of Eggs in Cooking
- What are Different Types of Complementary
and Alternative Medicine? - Tips for Remembering to Take Your Medicine
- What is Medicare Part E?
- Building Your Basic At-Home Senior Gym
- How to Make Stovetop Popcorn
- Medicareful Travel: Senior Trip to New Orleans
- How to Navigate & Read Academic Articles
- Phytonutrients: What Plant Color Says About Nutrition
- How to Prevent or Reduce Inflammation
- Osteoporosis: Risk Factors, Signs, and Treatment
- How to Make Homemade Pretzels
- Researching Your Ancestry and Family Tree
- How Medicare and Social Security Work Together
- What is Nordic Walking?
- Food Questions You've Been Embarrassed to Ask
- How Medicare Changed for 2023 and Beyond
- Tips for Using a Microwave
- How to Clean Your Ears Safely
- Skiing as a Healthy Hobby for Seniors
- 3 More Great Places to Celebrate New Year's Eve
- Why Do We Celebrate That? More New Year's Eve Traditions
- Panettone, the Italian Christmas Dessert
- A Simple Homemade Gingerbread Recipe
- How to Make Christmas Decorating Jollier
- The Science of Winter Weight Gain
- Seasonal Picks: 3 Foods You Should Try This Winter
- 5 Tips to Make Getting Your Christmas Tree Stress-Free
- Show-Stopping Potato Side Dishes for Thanksgiving
- Dishes to Impress Your Friends: Boeuf Bourguignon
- Holiday Travel Tips to Reduce Stress
- Does Medicare Cover Pain Management?
- Is Hunting a Healthy Senior Hobby?
- Ways You Can Get More Politically Involved
- What are Medicare's Lifetime Reserve Days?
- Spooky Spots for Seniors Halloween 2022
- How to Make Soul Cakes for Halloween
- Jack O' Lantern Carving Tips for Halloween
- Easy Ways to Peel a Potato
- 2023 Social Security COLA Largest in Decades
- Exercise Tips for Autumn
- How to Make Candy Apples at Home
- Why are Medicare Insurance Sales Calls Recorded?
- Here's What Medicare Costs in 2023
- CMS Updates Medicare Enrollment Rules for 2023
- Medicareful Travel: Senior Trip to London
- Does Medicare Cover Insomnia Treatment?
- Healthy and Easy Homemade Dog Treats
- The FDA Finalizes Ruling to Increase Access to Hearing Aids
- What the Inflation Reduction Act of 2022 Means for Medicare
- Tips to Make Flying and Airports Less Stressful
- CMS Projects Lower 2023 Part D Average Costs
- The 15 Golden Rules of Airplane Etiquette
- How Often Should You Shower?
- What are Medicare Pilot Programs?
- How to Care for Your Cast Iron Cookware
- Confronting a Loved One About Hurtful Behavior
- What Does Creditable Coverage Mean for Medicare?