What can I do if I have a complaint about my plan?
You have the right to file a complaint with the plan. This is sometimes called a "grievance." Some examples of why you might file a complaint include the following:
- The plan doesn’t give you a decision about a coverage determination or first level appeal within the required timeframe.
- The plan didn’t make a timely decision on your coverage determination request tor first-level appeal and didn’t send your case to the Independent Review Entity(IRE).
- You disagree with the plan’s decision not to grant your request for an expedited coverage determination or first-level appeal (called a "redetermination").
- You have to wait too long for your prescription.
- You believe your plan’s customer service hours of operation should be different.
- The company offering your plan is sending you materials that you didn’t ask to get and aren’t related to the drug plan.
- The plan didn’t provide the required notices.
- The plan’s notices don’t follow Medicare rules.
If you want to file a complaint, you should know the following:
- You must file your complaint within 60 calendar days from the date of the event that led to the complaint.
- You may file your complaint with the plan over the telephone or in writing.
- You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
- If the complaint relates to a plan’s refusal to expedite a coverage determination or redetermination and you haven’t yet purchased or received the drug, the plan must notify you of its decision no later than 24 hours after it gets the complaint.
- If you think you were charged too much for a prescription, call the company offering your plan to get the most up-to-date price.
If the plan doesn’t take care of your complaint, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.