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Dear Marci,
I’m never sure where to start if I have questions or problems with my Medicare coverage. Who should I contact about these Medicare issues? -Juanita (Bar Harbor, ME) Dear Juanita,
This is a great question. When we are confused or concerned, who do we reach out to? Knowing where to start and which people to contact can help you more quickly and easily clarify confusions, solve problems, and stay informed. Let's discuss a few important groups that can help, and when to contact each.
First, contacting Medicare can help with many issues that arise. You can learn about coverage rules, ask questions about your Medicare Summary Notice (MSN), or check the status of your Part A or B claims. You can also contact Medicare to find forms for filing a Medicare appeal or to let someone speak with Medicare on your behalf. Medicare assists you in comparing costs and coverage of Medicare Advantage Plans, Part D plans, and Medigaps in your area. Medicare staff can even help you enroll in a plan or find health care providers and suppliers in your area that participate in Medicare. You should also contact Medicare to request a replacement Medicare card. To contact Medicare, you can either call 1-800-MEDICARE or go to www.medicare.gov. On its website, Medicare has some helpful tools to learn about plans and providers:
Sometimes you may want to contact the Social Security Administration (SSA). You can call SSA at 800-772-1213. It may be helpful to contact SSA about enrollment-related topics, such as to enroll in Medicare Part A and B or to correct issues with your Medicare Part A and B effective dates. You can also contact Medicare to appeal a higher premium (called IRMAA) or to find the application for Extra Help. You should additionally contact SSA to report a change of address or phone number.
If you have concerns about the quality of medical care you have received, you should contact your Beneficiary and Family Centered Care—Quality Improvement Organization (BFCC-QIO). You can find your BFCC-QIO by visiting www.qioprogram.org/contact. A staff member can help you access and complete the quality-of-care complaint form. Examples of qualify of care complaints may be if you received unnecessary or inappropriate surgery or treatment, or if you experienced prescription drug errors.
Now, who should you contact if you think you’re experiencing not just a coverage issue, but perhaps Medicare fraud, errors, or abuse? Call your local Senior Medicare Patrol (SMP). SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect and report health care fraud, errors, and abuse. You can find your SMP by calling 877-808-2468 or visiting www.smpresource.org.
Finally, if you need more assistance and individualized counseling, you can reach out to your local State Health Insurance Assistance Program (SHIP). Trained staff there can provide unbiased, knowledgeable counseling on your Medicare coverage. To contact your SHIP, visit www.shiphelp.org or call 877-839-2675.
I hope this can help you better understand who to contact and when! Feel free to keep this saved for the next time you feel confused with your Medicare or you experience any problems. -Marci |
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Eastern Area Agency on Aging now has an easy, secure way for providers to send us referrals for clients or patients who need to access our services. The electronic link below is a HIPPA compliant form that any provider can use to request assistance from EAAA for any of our programs. EAAA staff will follow-up with you after receiving the referral to ensure effective and accurate communication about the needs of the person you are referring. |
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