endstream endobj 120 0 obj <>/Subtype/Form/Type/XObject>>stream 2.16 1.68 6.6 3.96 re 0.5 0.5 0.5 rg endstream endobj 123 0 obj <>/Subtype/Form/Type/XObject>>stream Our staff will work with you to try to find a satisfactory solution to your problem. We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your grievance. If your Level 2 Appeal is turned down and you meet the requirements to continue with the appeals process, you must decide whether you want to go on to Level 3 and make a third appeal. The Level 3 Appeal is handled by an administrative law judge. This person can be a relative, friend, lawyer, advocate, doctor or someone else. Online: Within sixty (60) days from the date of the notice of coverage determination, you may submit a Redetermination Request Form online here: You are unhappy with the quality of the care you received. 1 800-373-3177 (TTY: 711), 2020ArchCarethe Continuing Care Community of the Archdiocese of New York. f View recent announcements. As a member of Advantage MD, you have a right to request a coverage decision. You must have JavaScript enabled to use this form. For other types of problems, you need to use the process for making complaints, which are also called grievances. The exception forms can be submitted online, by fax, or by mail. If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and mail it to us. Read more about coronavirus. If you want a Provider or Pharmacy Directory mailed to you, or if you need help finding an in-network provider, please call Customer Service, October 1 through March 31, Monday through Sunday, 8 a.m. to 8 p.m., and April 1 through September 30, Monday through Friday, 8 a.m. to 8 p.m. PPO network: call 877-293-5325 (TTY: 711) HMO network: call . Box 8777, Elkridge, MD 21075. This can be a relative, friend, a healthcare professional or lawyer, or any other person or organization you want to represent you. We will give you our decision sooner if you have not received the drug yet and your health condition requires us to do so. All appeals requests must include a completed and signed Waiver of Liability Form. We honor your rights, take your problems and concerns seriously, and treat you with fairness and respect. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . This page was last updated: September 30, 2022 at 9:12 pm EST. To make a Level 2 Appeal, you must contact the Independent Review Organization and ask for a review of your case. When you appeal a decision for the first time, this is called a Level 1 Appeal. 0 0 0 rg Box3538, Scranton, PA 18505. With useful Medicare information delivered right to your inbox. Most complaints are answered within 30 days. When you make an appeal, we review the coverage decision to check if we were following all of the rules properly. From April 1September 30, you will need to leave a message on weekends and holidays. The Office of the Medicare Ombudsman can also help you with complaints and grievances. Johns Hopkins Advantage MD Appeals and Grievances, P.O. The balance is your responsibility, but that's still an amazing deal! What we mean by "vision benefits" are the extras, like a free or low-cost annual vision exam or money towards the purchase of new lenses or frames. There are two types of formal processes for handling problems and concerns: Both of these processes are approved by Medicare. It is located at 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224. In this appeal, we review the coverage decision we made to check to see if we were following all of the rules properly. I look forward to helping you! A coverage decision is any decision made by the plan regarding: Any time that we make a decision about what we will cover and how much we will pay for your medical services or drugs, we are making a coverage decision. EMC hYo8WK N5q4Wl,7],&Efh4 S!*6"| -#0!'@-qD@)4,U`U"M}up"x#P$"d8@D I am interested in ArchCare services and would like more information. If the plan denies coverage for your requested item or service, you have the right to appeal and ask us to reconsider the decision. There are Medicare Advantage Plans on the Eastern Shore that include both preventative and comprehensive dental coverage. This is called a "Trial Right" and you can read about it on Medicare.gov's website. What to do if you have a problem or complaint (coverage decisions, appeals, complaints) in the Evidence of Coverage. You can only end your membership with Johns Hopkins Advantage MD during certain times of the year. /Tx BMC Johns Hopkins Enterprise Directory v.5.38.1. Johns Hopkins Advantage MD P.O. Contact us promptly either by phone or in writing. By phone: 18003733177 (TTY/TDD 711), seven days a week, 8 a.m. to 8 p.m. By mail: Appeals & Grievances Department, 205 Lexington Avenue, 8th Floor New York, NY 10016. What if the review organization says no to your appeal? If you have questions about ending your membership with Johns Hopkins Advantage MD, please call us . So if you live on the Eastern Shore, and your networked Doctor is in Annapolis, you will probably be able to have the Medicare Advantage Plan's transportation benefit handle your transport to and from the visit! You or your appointed legal representative may file a grievance. An appeal is a formal way of asking the plan to review and change a coverage decision we have made. This means you can go to the plan's networked vision specialists (like Pearl Vision) and buy a pair of prescription glasses (or contacts) and the first $150 of the purchase is covered by the Eastern Shore Medicare Advantage Plan. endstream endobj 131 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 135 0 obj <>/Subtype/Form/Type/XObject>>stream If you have questions about the appeals process or would like to know the status of an appeal youve filed, please call us. Yorb Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Requesting an appeal (redetermination) if you disagree with Medicare's coverage or payment decision. If this organization says no to your appeal, it means the organization agrees with our decision not to approve your request. TTY users can call 711. If we decide to take extra days, we will tell you in writing. Starting in 2022, there will be four new companies to enter into the Eastern Shore counties. Box 3507, Scranton, PA 18505. EMC If you decide to keep your Advantage plan past this 2 year trial period, and later decide to go back to any Medicare Supplement plan, you will be required to answer health questions at that time. Submit one form unique to the member. Don't rule out these Advantage Plans simply because you heard something bad about them. If you do so, your membership will end when your new plans coverage begins on January 1. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request. Box 3538 Scranton, PA 18505 Fax: 855-825-7723 Once they process your request to join, they'll contact you. Por favor llame a nuestro nmero de servicio al cliente al 800-373-3177, TTY 711, de domingo a sbado, de 8:00 am-8:00 pm. If you are making a complaint because we denied your request for a fast coverage decision or a fast appeal we will automatically give you a fast complaint. Annapolis Junction, MD 20701. Johns Hopkins Advantage MD, P.O. However, if you ask for more time, or we need to gather more information that may benefit you, we can take up to 14 more calendar days. Please contact our customer service number toll-free at 1-800-373-3177, seven days a week, 8 a.m. 8 p.m. (TTY/TDD: 711). H23U0t.C=0agn`ghPe @F !C=33=3c=K Regardless of whether we agree or not, we will notify you of our decision by phone within 24 hours and will send you written follow up. See your Evidence of Coverage for more specific information on how to end your membership. All you need is Medicare parts A & B and live in one of the counties serviced by the plan. /Tx BMC If you decide to go on to a Level 2 Appeal, the Independent Review Organization reviews the decision we made when we said no to your first appeal. Notice of Nondiscrimination: Johns Hopkins Advantage MD (PPO) and Johns Hopkins Advantage MD (HMO) comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. endstream endobj 117 0 obj <>/Subtype/Form/Type/XObject>>stream I've seen savings as high as 70% using this type of benefit. 8 a.m.-8 p.m., 7 days a week. To request a coverage decision regarding payment requests you or your representative may: Johns Hopkins Advantage MD, PO BOX 3537, Scranton, PA 18505. Johns Hopkins Advantage MD is available to residents of these counties: document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); I would like a representative to call me to speak about questions regarding enrolling in a plan. =`r&wH0dPU|0y,~L8w>da8fg"%`v' To start your appeal, you, your doctor or your representative must contact our plan. endstream endobj 138 0 obj <>/Subtype/Form/Type/XObject>>stream If we are using standard deadlines, we must give you our answer within 30 calendar days after we receive your appeal if your appeal is about coverage for services you have not yet received. What typically sets Advantage Plans apart are these little "extra" benefits found in the Summary of Benefits. If the dollar value of the coverage you are requesting meets the requirement, you choose whether you want to take your appeal further. To do so, you must complete, sign and send us an Appointment of Representative form that gives that person or organization permission to speak with us and make decisions for you. Please note that by clicking Request Information, I expressly, give permission for a sales agent from an ArchCare Medicare. You can go back to your Medicare Supplement plan at ANY TIME within the first 12 months of trying a Medicare Advantage Plan for the first time (this must be your first time on a Medicare Advantage plan), without any medical questions. Prior to 2022, Advantage Plans were extremely limited in this are of Maryland. without needing any extra dental insurance coverage. HMO members: 877-293-4998 (TTY:711). Print, fill out and sign the form, and either mail or fax it to us. The balance is your responsibility, but that's still an amazing deal! This is a Medicare rule, people just don't know about it. endstream endobj 124 0 obj <>/Subtype/Form/Type/XObject>>stream Your membership will end on the first day of the month after we get your request to switch to Original Medicare. The QIO is a group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients. To continue and make another appeal at Level 3, the dollar value of the drug or medical coverage you are requesting must meet a minimum amount. /Tx BMC This information is available for free in other languages. By fax: Fax the completed Redetermination Request Form within sixty (60) days from the date of the notice of coverage determination to 18556337673. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. 1.08 1.08 8.76 5.16 re There's something here for everyone and you should at least look at the Summary of Benefits for each new Eastern Shore Medicare Advantage Plan. The Level 2 Appeal is conducted by an independent organization that is not connected to us. I can provide you with a Summary of Benefits for any Eastern Shore Medicare Advantage Plan, just email or call me. , see the appropriate fax number on the first time, this is called a complaint your On contract renewal for certain types of problems only, HMO, PPO or D-SNP ( HMO ) depends contract 2 appeal, make your appeal is a brand new company for 2022 and has some amazing plan offerings Maryland Start your appeal is a brand new company for 2022 and has some amazing plan offerings throughout.! 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