|
|
|
|
|
|
|
Section 2: Other Medicare Health Plans (continued)   |
|
Q: If I join a Medicare managed care plan will I lose any of my Medicare covered services? A: When you join a Medicare managed care plan, you are still entitled to all the covered services of the Medicare program. All Medicare managed care plans must provide, at least, all the services covered under the Original Medicare Plan. This includes Part A (Hospital Insurance) and Part B (Medical Insurance). Hospice benefits are provided by a Medicare- approved hospice in your service area. Medicare managed care plans also may provide additional benefits. Q: How do I question or appeal a Medicare managed care plan coverage decision? A: You have a right to appeal many decisions about your Medicare-covered services. You have this right if you are enrolled in a Medicare managed care plan. Your health plan must provide you with written instructions on how to appeal. You may file an appeal if your health plan denies a service, or terminates or refuses to pay for services that you believe should be covered. After you file an appeal, the health plan reviews its decision. Then, if your health plan does not decide in your favor, the appeal automatically goes to an independent review organization that contracts with Medicare. You may be eligible for a fast decision (within 72 hours) if your health or ability to function could be seriously harmed by waiting the amount of time needed for a standard decision. See the health plan’s membership materials or call your health plan for details about your Medicare appeal rights. If you believe you are being discharged too soon from a hospital, you have a right to immediate review by the Peer Review Organization* (PRO). During the immediate review, you may be able to stay in the hospital at no charge and the hospital cannot discharge you before the PRO reaches a decision. * You can find phone numbers for your area in your copy of Medicare & You or on the Internet at www.medicare.gov under Important Contacts. Q: Can I find out how a Medicare managed care plan pays its doctors? A: Medicare managed care plans’ current members and those interested in joining the plan have a legal right to know (in writing) how the plan pays its doctors. If you want this information, call the plan. |
|
|
|
|
|
|
|
Get the Savvy Consumer Newsletter! (FREE)
|
|