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Individual & Family Health Insurance
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Welcome to


How do you file a complaint (grievance)?
Find out how you can file a complaint (also called a “grievance”) if you have a concern about the quality of care or other services you get from a Medicare provider.

How do you file an appeal?
An appeal is the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan.

1.  Your request for a health care service, supply, or prescription that you think you should be able to get.
2. Your request for payment for health care or a prescription drug you already got.
3. Your request to change the amount you must pay for a prescription drug.

If you decide to appeal

The appeals process has 5 levels. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you’ll be given instructions in the decision letter on how to move to the next level of appeal.

1. Original Medicare appeals
2. Medicare health plan appeals
3. Medicare prescription drug coverage appeals
4. Special Needs Plan appeals
5. Appointing a representative

Your right to a fast appeals

Understand how you can get a fast appeal in certain situations. If you’re getting Medicare services from a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility,or hospice, and you think your Medicare-covered services are ending too soon, you’ve the right to a fast appeal.

How do you get a fast appeal?

1. Fast appeals in a hospital
2. Fast appeals in a non-hospital setting

Get Medicare forms

1. I want to make sure Medicare can give my personal health information to someone other than me.
2. I want to file a claim for services and/or supplies that I got. .

Appeals forms

1. I want to appoint a representative to help me file an appeal.
2. I want to transfer my appeal rights to my provider or supplier.
3.  Want to request an appeal (redetermination) because I disagree with a coverage or payment decision from Medicare (1st level of the appeals process).
4. I want to request a reconsideration because I’m not satisfied with the decision made during the 1st level of my appeal.
5. I want to request a hearing by an Administrative Law Judge (ALJ) because I’m not satisfied with the decision made during the 2nd level of my appeal.