Question: What are my rights as a consumer?
Answer: If you have Medicare, you have certain guaranteed rights to help protect you. One of these is the right to a fair, efficient, and timely process for appealing decisions about health care payment or services. Some of the reasons you may appeal are when:
- You don’t agree with the amount that is paid
- A service or item isn’t covered and you think it should be covered
- A service or item is denied and you think it should be paid
- Receive information
- Receive emergency room services
- See doctors; specialists, including women’s health specialists; and go to Medicare-certified hospitals
- Participate in treatment decisions
- Know your treatment choices
- Get information in a culturally competent manner in certain circumstances (for example, get information in languages other than English from Medicare, and its providers and contractors)
- File complaints
- Nondiscrimination
- Have your personal and health information kept private
You must be given instructions for filing an appeal. These instructions are on the Medicare Summary Notice. If you decide to file an appeal, ask your doctor or provider for any information that may help your case. You can also call the State Health Insurance Assistance Program in your state for help filing an appeal. To get the telephone number, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
In addition, you have rights to:
For more information about your rights and protections, you can get a free copy of the booklet Your Medicare Rights and Protections (CMS Pub. No. 10112) at How to Get Free Medicare Publications.
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