How do you appeal to Medicare if you have been denied coverage for a medical service? How do you lodge a complaint about a provider?
The United Hospital Fund provides a list of numbers for each state on their website:
Starting August 1, 2014, the contacts for appealing to Medicare have changed. Usually, these appeals are against a discharge (such as from a hospital or subacute rehab) or a denial of service (such as skilled rehabilitation at home). These organizations also deal with complaints about care covered by Medicare.
To file an appeal or a complaint with Medicare, contact the organization for the state where the care was provided.
The number for people in Arizona to call is 866-815-5440.
The New York Times has an article about how difficult it was to find the Medicare phone number for making an appeal or lodging a complaint. From the article:
On Aug. 1, Medicare made what should be a simple change in this process: There are new toll-free phone numbers to call. You may have already received the new numbers on the forms a hospital or nursing home provided about your rights. But if a health care provider hasn’t yet caught up with the change, you may not have.
Information about making appeals or complaints to Medicare can be found at http://medicare.gov/claims-and-appeals/index.html
Medicare Advantage Plans
For the nearly 50% of Arizona Medicare beneficiaries who are enrolled in Medicare Advantage plans, any complaints or appeals must be made to their Advantage plan. They can get the contact information by calling the Customer Service number on the back of their Medicare Advantage id card. These folks don’t call Medicare because Medicare doesn’t pay their bills – the insurance company that runs their Medicare Advantage plan does.