Part D appeals
Part D appeals Introduction to Part D appeals Requesting a tiering exception The Medicare Prescription Drug Coverage and Your Rights notice Appealing the Part D late enrollment penalty
Archive for September, 2018
Medicare Advantage appeals if your care is ending
If you are receiving care from a hospital, skilled nursing facility (SNF), Comprehensive Outpatient Rehabilitation Facility (CORF), hospice, or home health agency and are told that your Medicare Advantage Plan will no longer pay for your care (meaning that you will be discharged), you have the right to a fast
Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is the notice that your Medicare Advantage Plan or Part D prescription drug plan typically sends you after you receive medical services or items. You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a
Medicare Advantage post-service standard appeals
If you have a Medicare Advantage Plan and were denied coverage for a health service or item that you have already received, you may choose to appeal to ask your plan to reconsider its decision. Follow the steps below if you think the denied health service or item should be
Medicare Advantage pre-service standard appeals
If you have a Medicare Advantage Plan and you were denied coverage for a health service or item before you received the service or item, you can appeal to ask your plan to reconsider its decision. Follow the steps below if you feel that the denied health service or item
Medicare Advantage appeals
Medicare Advantage appeals Medicare Advantage pre-service standard appeals Medicare Advantage post-service standard appeals Explanation of Benefits (EOB) Medicare Advantage appeals if your care is ending
Filing a grievance
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
Fraud defined
Medicare fraud occurs when someone knowingly deceives Medicare to receive payment when they should not, or to receive higher payment than they should. Committing fraud is illegal and should be reported. Anyone can commit or be involved in fraud, including doctors, other providers, and Medicare beneficiaries. A provider is committing
Outpatient provider services
Outpatient provider services Hospice basics Hospice costs and coverage Medicare Advantage and hospice Drug coverage under hospice Hospice and skilled nursing facility (SNF) care Continuing hospice past your initial prognosis Ending hospice
Ending hospice
If you decide you want curative treatment (instead of just palliative treatment), you have the right to stop hospice at any time. Speak with your hospice doctor if you are interested in stopping. If you end your hospice care, you will be asked to sign a form that includes the