Despite the hope that Medicare Advantage (MA) plans would offer valuable supplemental benefits (including dental, vision and hearing benefits), recent studies do not show that MA beneficiaries are getting more supplemental services than those enrolled in traditional Medicare. In addition, all their services have to go through prior authorization (PA), which delays and often denies care that would have been covered under traditional Medicare. And MA patients still have very high out of pocket costs (“deductibles”) that, depending on the plan, may be thousands of dollars. I’ve blogged before on what I call the Medicare Dis-Advantage plans for wound care patients.
Finally, there is an easy way to complain to CMS about these issues with MA. The Centers for Medicare & Medicaid Services implemented an online process allowing health care providers to submit complaints about Medicare Advantage plans directly to the agency – available on CMS.gov.
As explained in a memo to all Medicare Advantage organizations, complaints submitted through the form will be routed to the Health Plan Management System Complaints Tracking Module. Submitted complaints will enter a queue within the Complaints Tracking Module, where CMS staff will review and triage them before assigning a contract number. The update represents a formalized mechanism for providers to raise concerns directly with CMS regarding Medicare Advantage plans, including issues related to claims, denials, or plan administration.
You can access the form directly or:
- Go to the CMS Home Page.
- Select “Medicare” from the top left dropdown menu.
- Select “Health & drug plans” from the left-hand navigation.
- Select “Report a provider complaint about an MA plan.”
The online form will capture basic information about the complainant, beneficiary, provider, and Medicare Advantage plan, a complaint summary, and optional fields for date(s) of service and claim number.
Related posts:
- New Proposed Rules to Help Protect Patients from Medicare Disadvantage Plans – Caroline Fife M.D.
- Tales of the Medicare Disadvantaged – Caroline Fife M.D.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
