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:
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.