Filing a Complaint about Your Medicare Drug Plan

A Medicare Prescription Drug Plan can be an excellent component in ensuring you have the health coverage you need.  However, even with a carefully chosen drug plan, you may run into issues.  Fortunately, if you are having problems, you can choose to file a complaint with your plan.

A complaint, termed a grievance, can be filed for a number of valid reasons.  For instance, if you have made a first-level appeal, or asked for a coverage determination, and you haven’t received a response in the required timeframe, you may want to file a grievance.  You may also want to file a complaint if your plan has decided not to approve your request for expedited coverage determination or first level appeal.  You may choose to file a complaint if your plan failed to supply you with necessary notices, or if the notices don’t follow standard Medicare regulations.  Another reason you may file a complaint is if feel your pharmacy has charged you more than you think you should have been charged or if you have had to wait an exorbitant time for a prescription.  Finally, think about filing a complaint if you don’t think your plan’s customer service hours of operation are fair or if your plan’s company is sending you materials not related to the drug plan (which you didn’t request).

As an individual with a Medicare Prescription Drug Plan, you have the right to file a grievance with your plan.  You have 60 calendar days from the event leading to your complaint to file.  If you feel you have been treated unjustly, file your complaint as soon as possible.