Complaints about your health or drug plan could include:
- Customer service: For example, you think the customer service hours for your plan should be different.
- Access to specialists: For example, you don't think there are enough specialists in the plan to meet your needs.
- Information from your plan: For example, the company offering your plan is sending you materials you didn’t ask to get and aren’t related to your plan, or the plan’s notices don’t follow Medicare’s rules.
- Problems with an appeal: For example, the plan isn’t following the appeals process or you disagree with the plan’s decision not to grant your request for a fast appeal or fast coverage determination.
- Drug errors: Like being given the wrong drug or being given drugs that interact in a negative way.
To file a complaint about your Medicare prescription drug plan:
- You must file it within 60 days from the date of the event that led to the complaint.
- You can file it with the plan over the phone or in writing.
- You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
- If it relates to a plan’s refusal to make a fast coverage determination or redetermination and you haven’t purchased or gotten the drug, the plan must give you a decision no later than 24 hours after it gets the complaint.