Member Rights and Responsibilities

Medicare Member Rights1

If you have Medicare, you have the right to be:

     

  • Treated with courtesy, dignity and respect at all times.
  • Protected from discrimination. Every company or agency that works with Medicare must obey the law. They can't treat you differently because of your race, color, national origin, disability, age, religion, or sex.
     

You have the right to have:

 

  • Your personal and health information kept private.
  • Access to doctors, specialists, and hospitals for medically necessary services.

 

You have the right to get:

 

  • Medicare-covered services in an emergency.

  • Information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
  • Information about your treatment choices in clear language that you can understand and participate in treatment decisions.
  • Medicare information and health care services in a language you understand.
  • Your Medicare information in an accessible format, like braille or large print.
  • Answers to your Medicare questions.
  • A decision about health care payment, coverage of items and services, or drug coverage.

 

When you or your provider files a claim, you’ll get a notice letting you know what will and won’t be covered. This notice may come from:
 
  • Medicare
  • Your Medicare Advantage Plan (Part C) or other Medicare health plan
  • Your Medicare drug plan for Medicare drug coverage (Part D)

 

If you disagree with the decision on your claim, you have the right to file an appeal. You may:

     

  • Request a review (appeal) of certain decisions about health care payment, coverage of items and services, or drug coverage.
  • File complaints (sometimes called “grievances"), including complaints about the quality of your care. You may decide to do this if you have concerns about the quality of care and other services you get from a Medicare provider.

 

1Medicare.gov, Your Rights

Medicare customers have the responsibility:

 

  • To know and confirm your benefits before getting treatment.
  • To show your member ID card before getting services.
  • To protect your member ID card from being used by another person.
  • To verify that the Provider you get services from is part of the health plan network.
  • To keep scheduled appointments.
  • To pay any copayments/coinsurance at the time you get treatment.
  • To ask questions and understand the care you are getting.
  • To follow the advice of your Provider and be aware of the possible outcomes if you do not.
  • To tell us your opinions, concerns and complaints.
  • To give information when asked to the health plan and contracted Providers that would help improve your health status.
  • To use emergency room services only for an injury or illness that you might think may be a serious threat to your life or health.
  • To follow the treatment plan agreed upon by you and your Provider.
  • To give all the health plan staff respect and courtesy.
  • To tell us of any change in address.

If you have questions or concerns about your rights, please call UnitedHealthcare Customer Service at the phone number listed on your member ID card. If you need help with communication, such as help from a language interpreter, customer service can assist you.

 

The Medicare program has written a booklet called Your Medicare Rights and Protection. To get a free copy, call toll-free 1-800-MEDICARE (1-800-633-4227) or TTY (1-877-486-2048) 24 hours a day, 7 days a week. Or you can access the Medicare website, to order the booklet or print it from your computer.

Appeals and grievances

 

As a plan member, you may request statistical information on appeals and grievances by contacting the UnitedHealthcare Appeals and Grievances Department:

Phone (toll-free):


FED TFN (TTY 711)
Hours of Operation: Every day, 8 a.m.–8 p.m.

Mail:


UnitedHealthcare
Attn: Appeals and Grievances
P.O. Box 6106
Cypress, CA 90630
Mail Stop: CY124-0157