March 22, 2007
MEDICARE PATIENT RIGHTS
Medicare beneficiaries, by law, have certain guaranteed rights, whether they are in the Original Medicare Plan, a Medicare Advantage (HMO or PPO) plan, or a Private Fee-for-Service plan.
Medicare beneficiaries have the following rights:
Information: You have the right to receive easy-to-understand information about Medicare; what Medicare pays, how much the beneficiary must pay, and how to file a complaint.
Emergency Care: You have the right to receive emergency care when and where it is needed without prior approval, anywhere in the United States. To avoid denial of coverage, study your health plan to fully understand what you have to do after emergency care has been rendered.
Appeals and Grievance: You have the right to file an appeal if Medicare does not pay for or doesn't provide a covered service, or file a grievance if you have a medical quality of care complaint.
Treatment Choices: You have the right to have the healthcare provider tell you about all treatment options in language that is understandable and clear to you.
Privacy: You have the right to have personal information that Medicare collects kept private.
MEDICARE MANAGED CARE PLAN - PATIENT RIGHTS
In addition to all the Medicare Patient rights above, beneficiaries in Medicare Advantage Plans have the following rights:
" The right to choose a women's health specialist from the plan's list of doctors for routine and preventative health care services.
" The right to a treatment plan from the doctor for a complex or serious medical condition.
" The right to receive complete information about his/her health treatment options.
" The right to know how a plan pays its doctors and whether the doctor owns any part of a health care facility.
The Massachusetts Peer Review Organization (MassPro) is a group of practicing doctors and other health care professionals paid by the federal government to review and monitor quality of care given to Medicare beneficiaries. MassPro processes appeals and quality of care complaints and grievances. To contact MassPro call: 1-800-252-5533.
If you need help on any aspect of your health insurance, SHINE offers free counseling at your Senior Center. Call your local COA and ask for a SHINE appointment. You can reach a SHINE volunteer by phone at 1-800-AGE-INFO. Once you get the SHINE answering machine, leave your name and number. A volunteer will call you back, as soon as possible. Please be patient. Due to the large volume of calls, you may not hear from us for several days.
SHINE (Serving the Health Information Needs of Elders) is coordinated by the Mass. Executive Office of Elder Affairs, in partnership with The Friends of the Milford Senior Center, Massachusetts Councils on Aging and other local agencies.
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