Today I’m doing something I’ve never done before here…I have a guest poster. Jon at PGM Billing, reached out and asked if there was an opportunity for a guest spot.
After a few emails, Jon presented this well written article geared towards Medicare beneficiaries. I thought it was perfect because I have been working on a Medicare post and this guest spot is motivating me to get it done. So, without further ado, and thank you Jon for reaching out, I want to introduce you to Jon Clark at PGM Billing.
10 Rights of All Medicare Beneficiaries
Medicare is a health insurance program developed to help the elderly people in the U.S. meet their hospital, medical and other health costs. It is available to most individuals 65 years of age and older.
Medicare is run by the Centers for Medicare & Medicaid Services, often referred to as CMS. It is a branch of the U.S. Department of Health and Human Services, or HHS, which is also the federal agency that runs the Medicare Program and monitors Medicaid programs offered by U.S. states.
Medicare has also been extended to persons under age 65 who are receiving disability benefits from Social Security or the Railroad Retirement Board, and those having end-stage renal disease.
While there are a number of different ways to become a Medicare beneficiary, there are special rights and protections guaranteed once you receive Medicare coverage. These rights and protections are designed to accomplish a number of objectives, including protecting Medicare beneficiaries when they receive healthcare, ensuring they receive the healthcare services that the law says they can receive, protecting them against unethical practices and protecting their privacy.
Here is a list of some of the different right and protections for all Medicare beneficiaries.
- No discrimination. All companies and agencies working with Medicare cannot treat you differently because of race, color, national origin, disability, age, religion or sex.
- Protection of personal and health information. By law, Medicare is required to protect the privacy of your personal medical information. Medicare is also required to inform you of how Medicare may use and give out (i.e., disclose) your personal medical information held by Medicare.
- Receive information you understand. Any information you receive from Medicare, healthcare providers, and, under certain circumstances, contractors must be presented in a manner that you understand.
- Receive information to help make healthcare decisions. You have a right to receive clear and simple information about Medicare that helps you make educated, informed decisions. This information would include a description of what services are covered by Medicare, what Medicare pays for those services, how much money you are responsible for paying for services and directions on how to file a complaint or appeal, if necessary. Proper medical billing can reduce billing mistakes. However, it is not uncommon for errors to occur that may require you to take action if you want to ensure you pay what you rightfully owe and not a penny more.
- Receive answers to questions about Medicare. You have the right to have your questions about Medicare answered. To do so, you can visit www.medicare.gov, call 1-800-MEDICARE (1-800-633-4227), call your state health insurance assistance program or call your plan if you have a Medicare Advantage Plan, other Medicare health plan or a Medicare Prescription Drug Plan.
- Access healthcare providers. You have a right to access physicians, specialists and hospitals.
- Learn about your treatment choices. You have the right to participate fully in all your healthcare decisions. Information about your treatment options must be provided in a clear language that you can understand. If you cannot fully participate, you have the right to ask a family member, friend or someone you trust to help make a decision about the treatment that is best for you.
- Receive services in an emergency. If your health is ever placed in danger because of an injury, sudden illness or illness that quickly gets worse, call 9-1-1. You have the right to receive Medicare-covered emergency care anywhere in the United States.
- Receive a decision about healthcare payment, service coverage and prescription drug coverage. When you request coverage for items or services, or a claim is filed for items or services you received, you will receive a notice from Medicare or be notified by your Medicare Advantage Plan, other Medicare health plan or Medicare Prescription Drug Plan informing you of what is and is not covered. If you disagree with the decision, you have the right to appeal.
- Be treated with dignity and respect. If this is ever not the case, you have the right to file a complaint (sometimes called “grievance”). Different from an appeal, which concerns issues with a plan’s refusal to cover a service, supply or prescription, a complaint concerns the quality of care or other services you receive from a Medicare provider. Learn more about how to file a complaint here.