I got poor customer service from my plan.
If you are unhappy with the customer service your Part D plan gave you, you can file what is called a grievance. A grievance is a complaint about the customer service that your plan has given you or about how your plan operates. You file grievances with your plan.
Grievances are only about the customer service your plan gives you. Customer service means things like answering your questions, or providing the information you need. But issues relating to what drugs your plan will pay for are not customer service issues.
If you have issues with coverage — for example, if your plan doesn't pay for a prescription you need — you would file an “exception” or “appeal.” You should not file a grievance if you have any questions or concerns about the coverage you have or want. In those situations, you should go through the exceptions or appeals process.
When can I file a grievance?
You can file a grievance with your Part D plan anytime you have a complaint about your plan's customer service. For example, if you call your plan for help and they cannot answer your question, you can file a grievance.
You have 60 days from the date you have the problem with your plan's customer service to file a grievance.
Who can file a grievance?
You, or someone else you trust, can file a grievance.
How do I file a grievance?
Contact your plan to ask how you should file your grievance. Usually you can file your grievance by phone or in writing. But some plans may need you to send them a special form.
After I file my grievance, what happens next?
Your plan must tell you what they will do about your grievance no later than 30 days after they receive it. But for certain types of complaints, your plan must respond sooner. Visit Medicare.gov for more information.
After your plan responds, there are no further steps. You cannot appeal your plan's decision about your grievance. But if your plan does not take care of your complaint, you should call Medicare at 1-800-MEDICARE (1-800-633-4227).
NEXT: Asking for an Exception