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Section 3: Medicare Protections and Rights   |
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Q: Does the Medicare program protect me from discrimination? A: Yes. Every company or agency that works with Medicare must obey the law. You cannot be treated differently because of your race, color, sex, national origin, disability, or age. If you think that you have not been treated fairly for any of these reasons, call the Office for Civil Rights* in your State. * 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: What can I do to protect myself and Medicare from fraud and abuse? A: You can help protect Medicare and yourself by reporting all suspected instances of fraud and abuse. Whenever you receive a payment notice from Medicare, review it for errors. Make sure Medicare did not pay for services, medical supplies, or equipment that you did not receive. If you have a questionable charge on your bill, call the provider, your Fiscal Intermediary* (for Part A bills) or your Medicare Carrier* (for Part B bills). If you believe that a health care provider may be cheating or abusing the Medicare program, call the Fiscal Intermediary or Medicare Carrier that sent you the payment notice. The Fiscal Intermediary’s or Medicare Carrier’s name, address, and telephone number will be on the payment notice. You may also call the Inspector General’s hotline 1- 800- HHSTIPS (1- 800- 447- 8477 or TTY/ TDD: 1- 800- 377- 4950 for the speech and hearing impaired) to report suspected cases of fraud. Medicare will not disclose your name if you request confidentiality. * 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: What are my rights as a Medicare patient? A: If you have Medicare, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan or a Medicare managed care plan. • You have the right to get emergency care when and where you need it, without prior approval. If you think your health is in serious danger because you have severe pain, a bad injury, sudden illness, or an illness quickly getting much worse, you can get emergency care anywhere in the United States. • You have the right to appeal if Medicare does not pay for a covered service you have been given, or if your doctor or hospital does not give you a service that you believe should be covered. See pages 16 and 28 for more information about appeals. • You have the right to know all your treatment options from your health care provider in language that is clear to you. Medicare must give you information about what is covered and how much you have to pay. Medicare managed care plans cannot have rules that stop a doctor from telling you everything you need to know about your health care, including treatment options. • You have the right to have any personal information that Medicare collects kept private. Medicare may collect information about you as part of its regular business, such as paying your bills. The law requires Medicare to keep this information private. When Medicare asks for this kind of information, we must tell you that the law lets us collect it for payment and health treatment purposes. You have the right to know why we need it, whether it is required or optional, what happens if you don't give the information, and how it will be used. If you want this information, call 1- 800- MEDICARE (1- 800- 633- 4227) and ask for more information about how Medicare uses personal information. What are my rights if I am in a Medicare Managed Care Plan? • You have a right to choose a women's health specialist from your plan's list of doctors to meet your women's health care needs. • If you have a complex or serious medical condition, you have a right to have enough visits to a specialist to deal with your needs. • You have a right to know how your plan pays its doctors. If you want to know how your plan pays its doctors, the plan must tell you in writing. You also have the right to know whether your doctor owns all or part of a health care facility. For example, a lab that he or she refers you to for a blood test. • If you have concerns or problems with your plan which are not about payment or service requests, you have a right to file a grievance. A grievance is a type of complaint. For example, if you believe your plan's hours of operation should be different, you can file a grievance. If you believe you are not getting a high quality of care, you may either file a grievance with your plan or with the Peer Review Organization (PRO) in your State. If you think any of your rights have been violated, please call the State Health Insurance Assistance Program in your State. Their number appears in your copy of Medicare & You or can be found on the Internet at www.medicare.gov. |
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