FAQs: Important Information About Medicare | Kaiser Permanente

With a Kaiser Permanente Medicare health design, you have a range of guarantee rights and protections, including :

  • timely access to covered services and drugs
  • Fair and respectful treatment at all times
  • The right field to file a complaint
  • security and privacy for your health information
  • distinctly explained treatment options and participation in making decisions about your treatment options
  • The right to get plan data and discussion explanations in a lyric or format that works for you ( including languages early than English, Braille, large print, and audiotapes )

Find more details in your plan ’ south documents, such as the Evidence of Coverage, or in the Medicare & You handbook available at medicare.gov . You besides can call Medicare at 1-800-MEDICARE ( 1-800-633-4227 ) ( TTY 711 ), 24 hours a day, 7 days a week .
q : How do I ask for coverage for a checkup service or requital of a circular ?
A : To request a coverage decision ( besides called an arrangement determination ) about medical services you ’ d like but seaport ’ thymine received, or about payment of a poster, contact Member Services .
A response for a standard request for wish or services can take up to 14 calendar days. A reply for a request for payment can take up to 30 days. If your health requires a flying response, you should ask us to make a “ fast coverage decision. ” You, your repair, or your representative can make the request for checkup care. We ‘ll respond to a firm coverage decision within 72 hours. If we say no to your request for coverage for checkup care or requital, you can ask for an appeal.
q : How do I make an attract ?
A : If we say no to your request for coverage for checkup care or payment of a bill, you have the properly to ask us to reconsider by making a Level 1 Appeal. You ’ ll need to make your appeal request within 60 calendar days from the date on the written notice we send you with our answer to your request for a coverage or requital decision.

  • For a standard attract, write to Member Services
  • If your health requires a agile response, ask for a “ fast invoke ” by writing or calling Member Services . You, your doctor of the church, or your example can do this. If your representative is appealing our decision for you, your appeal must include an Appointment of Representative form authorize this person to represent you. We ’ ll consider your invoke and give you our answer :

    • Within 72 hours for a fast appeal
    • Within 30 calendar days for a standard appeal request for checkup wish
    • Within 60 calendar days for a standard appeal request for payment of a bill
  • If we say no to character or all of your appeal, your shell will mechanically be sent to Level 2 of the appeals summons, which is done by an Independent Review Organization. That arrangement will review your attract carefully and give you its decision and reasons for it in writing .

For extra details, see chapter 9 in your Evidence of Coverage.
q : How do I make a complaint about Kaiser Permanente care, services, or processes ?
A : If you ’ re infelicitous with the medical worry or services you ’ ra getting, or if you ’ re infelicitous with our processes, you can make a charge. This is besides known as filing a grudge. call or publish to Member Services within 60 days of the incidental.
We ’ ll look into your complaint and give you our answer within 30 calendar days. For extra details, see chapter 9 in your Evidence of Coverage.
To get a summary of information about the appeals and grievances that plan members have filed with Kaiser Permanente, please contact Member Services .
You can besides use the on-line Medicare Complaint Form to send a complaint directly to Medicare.
q : How can I protect my privacy and personal information ?
A : Protect your identity by knowing how to recognize and report fraud. Do n’t give your Medicare title number, or other design data, to anyone other than your health plan representatives and the medical professionals and facilities that give you wish.
Look out for signs of fraud or leery offers. For exemplar :

  • Bills or statements for wish you never got
  • Bribes to get you to see an unfamiliar sophisticate or use services you do n’t need

Visit the Medicare web site for more information on preventing fraud. To report suspected imposter, call the toll-free number 1-877-7SAFERX ( 1-877-772-3379 ).

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