How to Use the Medicare Part D Grievances Process

Very few Medicare members know there is a Medicare part D grievances process they can go through when there is a serious concern about a Medicare part D plan. One of the main reasons people wait until the annual enrollment period to switch to another Medicare part D plan is because there is something that makes them unhappy with their current part D plan. They didn’t know there was a way to file a grievance or complaint against their company and have it reviewed. Because most people don’t know this, they stay with a plan they no longer like or trust.

The Medicare part D grievances process is one that allows members to file a complaint or dispute that has anything to do with the operations of the Medicare part D plan provider, their activities or the behavior of the employees. This process allows members to be heard by the plan provider and Centers for Medicare and Medicaid Services. When these grievances are filed, there must be a response given.

The Medicare Part D Grievances Process

Getting started in the Medicare part D grievances process is easy. When a member has had troubles with their part D provider, they have a right to file a grievance. That grievance can be filed over the phone with a representative or it can be written and mailed in. Members that are completely dissatisfied with something and don’t want to file the grievance with the part D plan provider can call CMS directly with the concern.

When filing a grievance, a member must know exactly what they are unsatisfied about. If a medication has been taken off the formulary and no warning was received by the member that is one reason to file a grievance. If a member has called and been refused help on how to get something done, grievances can be filed. When something happens, it’s important to start the Medicare part D grievances process within 60 days of the event happening. Once the process has been started, the Medicare part D plan provider must respond within 30 days unless it has been extended for up to 14 additional days.

Coverage Determinations Are Not Grievances

Some of the most common problems people have with their Medicare part D plans are requesting formulary exceptions and coverage determinations. While these are very important, they can’t be complained about using the Medicare part D grievances process unless:

  • The part D plan provider REFUSES to grant a request for an expedited coverage determination or redetermination
  • The member has NOT gotten the medication that is being disputed

Medicare part D plans can be very frustrating. Members can sometimes feel as if nothing they complain about will be heard. CMS knows this and has put the Medicare part D grievances process in place to help members have their concerns addressed. It’s because of the Medicare part D grievances process that new rules are made and enforced with Medicare part D plan providers.

Dec. 2 14'
I live in Maple Leaf, and ride the bus to and from work in downtown every day. I use route 77 most morinngs. My commute is actually *shorter* than it would have been by car: 25-30 minutes door to door to cover 6.5 miles. You can never do that driving in morning-commute trafficRoute 77 is one of those about to be cut. It has 9 buses going downtown in the morning commute, and 8 buses going back in the afternoon. Except perhaps for the 5:45 AM and 3:45 PM buses, this route is always full despite using a double-length bus. Where will all those riders go?The last #77 in the morning passes my house around 8:30, and it is always full. If I miss it I go down to the Northgate transit center and walk 15 minutes to catch the 41. At 9:15, #41 reverts from a high-frequency schedule to a 15-minute one. Nearly every morning the #41 buses right after that the 9:31 and 9:46 come in late and packed, and often leave workers stranded at the transit center unable to get to work.The morning scenario is roses and peaches compared to the afternoon situation. Nearly all of the #41s and #77 roll in late; the formal schedule has almost no meaning. Every day at least a couple of #41s fill up at Westlake or even at University tunnel stations, leaving riders in the remaining tunnel stops hoping another #41 arrives soon (which doesn't always happen). Yesterday this happened to me, except that it took the next #41 a while to arrive (and the #77 still didn't arrive 15 minutes after schedule). My door-to-door afternoon commute last night was nearly an hour, despite there being no major incident on the I-5.Your new plan for Metro (if one can call such negligence a plan ) not only cuts #77 completely, it also removes 17% of the 41 s. For residents in Northeast Seattle, it is a blueprint for commute disaster. After being stranded for a couple of days and missing work, even many loyal Metro riders will reach for their car keys. The city's northeast corner needs *more* commute buses, not less. #41 needs a higher frequency all the way through 10 AM. Another #77 needs to be added between 8:30 and 9. Not to mention the carbon-footprint of sending people back to their cars. Why are we even talking about cuts? Have people in the Legislature gone insane?I'm not done. I thought we were unlucky, and then one day last week I had to ride to an evening work meeting in Georgetown. I chose to use the #106 because it goes through the tunnel, and also because it had the best frequency during the afternoon commute. That would be a whopping 15 minute frequency during peak hours!The #106 came in 15 minute late, and took its precious time despite having a protected bus route for most of the way. It is not an express the way the #41 and #77 are. It took me 70 minutes 1 hour and 10 minutes to get to my destination, which is less than half the distance to my home and deep within the metropolitan core.I noticed another thing on the #106 that day. Who rode with me on the bus, whose final destination is Renton? Almost exclusively women of Asian descent. What a contrast to the #77 and #41, whose riders are a diverse mix including many in executive suits. Are the commuters living in the area between Georgetown and Renton all Asian women? No. Most likely, the commuters who can afford to do it (in the narrow financial sense) have already chosen to use their cars instead of the miserable #106.Senator Tom, you rose to the top of the State Senate using strange wheeling and dealing. What for, I am not sure. But if you continue blocking solutions on Metro and other essential transit services, you will be remembered as the Washington politician who had made the worst impact upon climate change in our generation.Sincerely yours,Assaf Oron, Ph.D.1240 NE 97th St Seattle WA 98115(who for over a decade hasn't used his car as the major commute mode)
Jul. 6 15'

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