Your Rights as a Patient
By Robert Goodman, MSW
Geriatric Social Worker
Medicare Appeal Rights
Do you know your rights as a healthcare consumer? Do you have a complaint about the quality of your care? Do you want to appeal a decision about a discharge from a hospital, skilled nursing facility, or home health care agency? An appeal is an action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or Medicare Prescription Drug Plan.
You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of the following:
- A request for a health care service, supply, item, or prescription drug that you think you should be able to receive.
- A request for payment of a health care service, supply, item, or prescription drug you already use.
- A request to change the amount you must pay for a healthcare service, durable medical equipment, or prescription drugs.
You may also appeal if Medicare or your plan stops providing or paying for all or part of a healthcare service, durable medical equipment, or prescription drug you think you still need. (Source: www.medicare.gov/claims-and-appeals).
Before filing an appeal, gather all the relevant information about the service you are appealing and the reason given for the denial of service or discharge. Then compile whatever documentation is necessary to show that you need that service to continue. This includes notes from a doctor, therapist, or another healthcare provider. Be sure the information is specific to your situation. Document every phone call, email or letter you write or receive.
Contact Kepro, the Medicare Quality Improvement Organization for Florida, at 1-844-455-8708 to file an appeal or a complaint about a service. You can learn more information about your right to appeal and download forms on their website, www.keproqio.com.
You can find interesting information on the Medicare.gov website about your rights and benefits. The website has sections where you can find and compare doctors, health plans, hospitals, medical equipment suppliers, nursing homes, home health agencies, dialysis centers, and other providers. You can also locate medical equipment suppliers.
Your Other Rights
You have the right to receive a copy of your medical records. You should keep a copy of your lab work, diagnostic reports, and other important medical information.
If you have a visual impairment, you have the right under the Americans with Disabilities Act (ADA) to request that your health care provider supply you with information written in large print. Under the ADA, any business or health care provider must make print documents available in an alternate format for people with visual impairments. This includes large print, Braille, or audio tapes. They also have the option of reading the material to a consumer.
The following are additional resources for information on health care providers:
Accreditation Association for Ambulatory Health Care
Finding out if urgent care centers and ambulatory surgical centers are accredited.
(847) 853-6060
American Association for Accreditation of Ambulatory Surgical Facilities
Finding out if an ambulatory surgical center is accredited. (888) 545-5222
American Board of Medical Specialties
Finding out if a doctor is board certified. (866) 275-2267
MAXIMUS Center for Health Dispute Resolution (CHDR)
Requesting external reviews of Medicare managed care denials.
(585) 425-5210
Florida Medical Quality Assurance Inc., The Florida ESRD Network – Network 7
Where to submit a complaint about the quality of care I received from my kidney dialysis facility.
Report Medicaid fraud and abuse: (866) 762-2237
Florida Agency for Health Care Administration
Where to submit a complaint about the quality of life or quality of care inside a nursing home. (888) 419-3456
Long Term Care Ombudsman of Florida
Obtaining information on nursing homes or resolving problems between nursing homes and residents or their families. (888) 831-0404, 561-837-5038
Florida Health Finder www.floridahealthinder.gov
Learn about medical conditions, symptoms, procedures, tests and more. Find and learn about Florida health care facilities and providers in your area.
Source: http://www.medicare.gov/contacts/topic-search-results.aspx