I Don’t Like My Medicare Part D Provider. Can I Change My Provider?

There are a lot of things that people need to be comfortable with. A Medicare Part D prescription drug plan provider is one of those things. When a person doesn’t have the support they need from their Medicare Part D provider, there is a chance they won’t want to continue using their services in the future. If there is a member that is adamant about not liking their provider, there are different things that can be done in order to get a better provider.

Their Responsibility

When an insurance company begins to offer Medicare prescription drug plans, they have specific rules they have to abide by. They are obligated to offer specific benefits to their members along with exacting information about those benefits. Because the benefits are confusing, Centers for Medicare and Medicaid Services require these insurance agencies to have customer service agents available to answer any questions and concerns that may occur regarding the benefits sold. When beneficiaries have a question, they should be able to call their insurance providers to get an explanation.

Complaints and Grievances

When a person has a problem with their prescription drug plan provider, they have a right to be heard. These insurance companies have particular customer service agents in place to work with these issues to get them resolved. As soon as a member has a problem, they should feel their concerns and issues are taken seriously and if there is something that can be done to remedy them, it should be done as soon as possible.

A complaint is something that most people have when they are unhappy with something. These are things that are sometimes able to be remedied and other times they are things that can’t be changed. Members that have complaints are often satisfied when they are able to air their complaints with their prescription drug plan providers. They don’t want to be ignored and realize they may not be able to have their issue resolved. It helps they have been heard and they have gotten a response.

When there is an issue that members of a prescription drug plan wants addressed, that is a grievance. This can be something small or large but it’s an issue that has to be resolved. These issues are sometimes concerning the formulary, the exclusions from certain benefits or many other things. When these grievances are filed, the members expect an answer. Many prescription drug plans have staff members that address the grievances that are filed or they are forwarded to a higher authority to be addressed.

It’s important for beneficiaries of a Medicare prescription drug plan to voice their concerns, complaints and grievances to their prescription drug plan providers. This is important for different reasons. The companies are able to gauge their services and know where they are failing their members. They are also able to improve their services and report the direct evidence when things should be changed. Although no company likes to hear they aren’t satisfying their clients, most companies appreciate the opportunity to make it right.

Not only do companies look for the complaints and grievances, the Centers for Medicare and Medicaid Services are also looking for them. This is one of the measures they use to ensure that a participating insurance provider is following the rules they have established. When a prescription drug plan provider has a huge number of complaints, CMS will investigate and begin monitoring how they operate their part D program. If there are direct violations, the company will get fined and stand a chance to lose their contract with the federal government.

Change Medicare Providers

There are some people that have had too many issues with their Medicare part D prescription drug plan providers or find they aren’t able to get the medications they need on a particular plan. Those that have evaluated their situations and find they don’t get the help they need have the option of changing their drug plan. Many people think that changing their Medicare drug plan will be difficult but it’s a simple process.

Every year there is an annual enrollment period. This enrollment period is a time that anyone can take advantage of, not just those that are new to Medicare and eligible for Medicare part D benefits. For those that want to make a change that is effective for the 2013 benefit year can make changes from October 15, 2012- December 7, 2012. There doesn’t have to be a particular reason that people need to enroll into a new drug plan during this time. The desire to use a different drug plan is all beneficiaries need. Those that choose to make a change should call the prescription drug plan they want to be a member of and enroll in their plan. There is no need to call the current insurance provider because once CMS receives the new application, they will inform the other company.

There are times that people want to enroll into a different prescription drug plan outside of the annual enrollment period. When this happens, members have to qualify for a special set of circumstances to get out of the plan. Those that think they qualify for one of these periods have to call their insurance provider or call the Centers for Medicare and Medicaid Services to begin the process.

When a person isn’t happy with their prescription drug plan, there are many different ways to have those concerns addressed. They can be addressed by talking directly with the insurance provider or they can be addressed with the Centers for Medicare and Medicaid Services. As people take advantage of their options and begin communicating, they will find their concerns are taken seriously. If there is no hope in salvaging the membership, all members have the option of switching insurance providers. Because medications are so important, it’s important that beneficiaries have a Medicare part D prescription drug plan provider they can trust and depend on.

Nov. 13 12'

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