We hope that all of your health care experiences are positive. But if theyâre not, we want filing a complaint to be as easy as possible. Thatâs why we offer you a variety of tools to express your concerns. One of those tools is the ability to file a complaint (sometimes called a âgrievanceâ).
Is your concern a complaint or an appeal?
A complaint is different than an appeal. A complaint is about the way your Medicare health plan, Medicare drug plan, or health provider is giving care. Examples of complaints are problems with:
- A doctor, hospital, or provider
- Your health or drug plan
- Quality of your care
- Your dialysis or kidney transplant care
- Durable medical equipment
Things to know before you file a complaint
If you have a complaint with your plan, each plan has specific rules youâll need to know and follow when filing a complaint. If, after filing a complaint, your plan doesnât address the issue, call 1-800-MEDICARE for help. For any Medicare-related complaint, you can call your State Health Insurance Assistance Program (SHIP) for free personalized help.
If youâve contacted 1-800-MEDICARE about a Medicare-related inquiry or complaint but still need help, ask the 1-800-MEDICARE representative to send your inquiry or complaint to the Medicare Ombudsmanâs Office. The Medicare Ombudsmanâs Office helps make sure that your inquiry or complaint is resolved.
In addition to basic information like your name and address, have your Medicare card and health plan card (if you have one) readily available when youâre ready to file your complaint. And, in the future, you can also use Medicareâs Blue Button to help. It provides you an easy way to download your personal health information to a file on your own personal computer. Check out the Blue Button through your account on MyMedicare.gov.
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