You have the right to make complaints and to ask us to reconsider decisions we have made.
If you have any problems or concerns about your covered services or care, Chapter 9 of your Evidence of Coverage tells what you can do. It gives the details about how to deal with all types of problems and complaints.
What you need to do to follow up on a problem or concern depends on the situation. You might need to ask our plan to make a coverage decision for you, make an appeal to us to change a coverage decision, or make a complaint. Whatever you do – ask for a coverage decision, make an appeal, or make a complaint – we are required to treat you fairly.
You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. To get this information, please call Member Services.
What can you do if you believe you are being treated unfairly or your rights are not being respected?
If it is about discrimination, call the Office for Civil Rights
If you believe you have been treated unfairly or your rights have not been respected due to your race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin, you should call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 or TTY 1-800-537-7697, or call your local Office for Civil Rights.
Is it about something else?
If you believe you have been treated unfairly or your rights have not been respected, and it’s not about discrimination, you can get help dealing with the problem you are having:
- You can call Member Services.
- You can call the State Health Insurance Assistance Program. For details about this organization and how to contact it, go to Chapter 2, Section 3 of your Evidence of Coverage.
- Or, you can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
How to get more information about your rights
There are several places where you can get more information about your rights:
- You can call Member Services at 1-800-247-1447 (TTY 711).
- You can call the SHIP. For details about this organization and how to contact it, go to Chapter 2, Section 3 of your Evidence of Coverage.
- You can contact Medicare.
- You can visit the Medicare website to read or download the publication “Your Medicare Rights & Protections.” By clicking this link, you will leave the Fidelis Care website.
- Or, you can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.