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| Appeals Procedure: An appeal is the type of complaint a Member makes when they want Freedom Health to reconsider and change a decision we have made about what services are covered for you or what we will pay for a service. Appeals may be made by calling the Member Services Department (toll free) at (800) 955-8771 or TTD/TTY at (800) 955-8771. You may also write us and request an appeal at: Freedom Health If you have a problem receiving care or payment for care there are six possible steps you can take to ask for the care or payment you want from Freedom Health. These steps are outlined in detail in the Explanation of Coverage (EOC) in Section 10 – Appeals and Grievances: What to Do if You have Complaints About Your Medicare Advantage Benefits, Section 11 – Detailed Information About How to Make an Appeal, and Section 12 – Appeals and Grievances: What to Do if You have Complaints About Your Part D Prescription Drug Benefits. This document is available by clicking here. This will take you directly to the web page and button for the current Explanation of Coverage. The section and pages in the EOC that address appeals may be found in the Table of Contents. Grievance Procedure: A grievance is the type of complaint a Member makes if they have any problem with Freedom Health or one of our in-network providers other than a problem regarding receiving care or payment. For example, you would file a grievance if you have a problem with things such as the quality of your care, waiting times for appointments or in the waiting room, or the way your doctors or others behave. Grievances may be made in writing to: Freedom Health Detailed information on the grievance process can be found by clicking on the Medicare Advantage – Freedom Medicare Plan button which will bring you to a page where you can view the EOC for your county. The Table of Contents will direct you to the appropriate Section and pages relevant to the grievance process. You may also contact our Member Services Department (Monday through Friday from 8:00 a.m. to 5:00 p.m.) for assistance with a grievance by calling (800) 401-2740 or for TTY users by calling (800) 955-8771. Coverage Determinations: Information on coverage determinations can be found in the EOC in Sections 10, 11, and 12. The Table of Contents in the EOC will direct you to the relevant pages regarding coverage determinations. You may also contact our Member Services Department Monday through Friday from 8:00 a.m. to 5:00 p.m. by calling 1-800-401-2740 or TTY users may call 1-800-955-8771. Exceptions Process: Information on the Freedom Health exceptions process may be found in the EOC. The Table of Contents will direct you to the relevant pages regarding the exceptions process. You may also contact our Member Services Department Monday through Friday from 8:00 a.m. to 5:00 p.m. by calling 1-800-401-2740 or TTY users may call 1-800-955-8771. Aggregated number and disposition of disputes: Information regarding the aggregated number of grievances and appeals and their disposition is available to the Member upon written request. The member may also request and receive written information regarding exceptions made by Freedom Health. The Member may request and receive this information by writing to the following address: Freedom Health Potential for contract termination: Freedom Health may terminate or refuse to renew its contract with the Centers for Medicare and Medicaid Services (CMS), or reduce the service area included in its current contract. More information on your Medicare coverage may be found in the “Medicare & You Handbook” published each year by CMS or at the CMS web site at http://www.medicare.gov . Member “rights and responsibilities” at disenrollment: Disenrollment from Freedom Health ends your membership with the Freedom Medicare Plan. If you leave the Freedom Medicare Plan, it takes some time for your membership to end and your new way of getting Medicare to take effect. Until your membership officially ends, you must keep receiving your Medicare services through the Medicare Patriot Plan or you will have to pay for these services yourself--with a few exceptions. These exceptions are urgently needed care, care for a medical emergency, out-of-area renal (kidney) dialysis services, and care that has been approved by Freedom Health. One other possible exception is if you happen to be hospitalized on the day your membership ends. If this occurs, you should contact Member Services to find out if your hospital care will be covered by the Freedom Medicare Plan by calling (800) 401-2740 or TTY users should call (800) 955-8771. | ||||
