Filing a complaint about a Medicare Advantage plan
A Medicare Advantage Plan is another way to get Part A and Part B coverage.
A Medicare Advantage Plan is another way to get Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.
Medicare pays a monthly amount to the private companies managing MA Plans, such as UHC, Cigna, Humana. These companies must follow the medical necessity coverage rules established by CMS. This means they must follow the appropriate Local Coverage Determinations (LCD)
What Does This Mean for You?
CMS monitors the MA Plans for customer service, access to specialists, and conformity to the LCDs. If you or your patients believe a MA Plan is not following the coverage guidelines, there are formats for appeals/complaints.
Use this online form to initiate your complaint. Have the plan name and ID ready. And provide a summary of the complaint. A representative from Medicare will contact you to follow up.