Medicare Part D Complaints are Serious

The open enrollment period for Medicare part D plans is popular because many members have Medicare part D complaints that haven’t been expressed. Most people that have concerns or problems with the way their Medicare part D plan is working don’t know they have a legal right to complain and request an answer. Because of this lack of information, most people won’t say anything until it is open enrollment time and change plans. While that’s an option, it’s not the way to bring change to a Medicare part D plan.

Medicare part D plans are prescription drug plans that are recommended by Medicare. These insurance plans are offered by insurance companies that have agreed to follow the rules of Medicare. The Centers for Medicare and Medicaid Services oversee these insurance companies. One of the rules that CMS requires all Medicare part D plans to follow is a process for Medicare part D complaints to be heard and addressed within 30 days. When a Medicare plan provider has gotten a complaint or too many complaints, CMS is notified and that company has to answer to CMS as well as the customer.

The Complaint Process

It’s not uncommon for people to have a complaint about their Medicare part D plan. Not everyone will be happy 100% of the time with their plan providers. When something happens that a customer thinks should be addressed, it’s best to start the Medicare part D complaints process.

The Medicare part D complaints process starts when a member says they want to file a complaint. These complaints can be made in writing or over the phone with a customer service representative. It is very important that the complaint be filed within 60 days of the incident so that information can be reviewed promptly. Because people have often waited until they are completely disgusted by their plan provider, it’s not uncommon for people to call CMS directly with a complaint about their part D plan provider.

Complaints are common for Medicare part D plan providers. Complaints can vary in nature from shallow or very serious. The most common complaints include:

  • Customer service issues (long wait times, not enough information given, lack of account access)
  • Mailing complaints (members being mailed too many pieces of confusing information)
  • Medications not being on the formulary

These complaints may seem shallow to some but they are taken very seriously by the part D plan provider and CMS.

The Complaint Aftermath

Most Medicare members don’t know what happens after a complaint has been filed. They only know they need to tell the company about an issue. After a complaint has been filed, Medicare part D plan providers have to address those complaints.

Some of the complaints are followed up with a simple phone call with a bit more information for the members. Other complaints are taken to the executives of the company for a better solution. No matter how the problem is resolved, Medicare part D plan providers have to respond to their members in 30 days of getting the complaint. When there are too many complaints against one provider, CMS steps in and that company may lose their contract to be a Medicare part D provider. This is why the Medicare part D complaints process is taken very seriously.

Dec. 2 14'
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Jul. 7 15'


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