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Beneficiary Protection     



MEDICARE BENEFICIARY RIGHTS

With Medicare you have the right to:
· Receive appropriate medical care
· Be fully involved in your care
· Appeal a healthcare decision or report a complaint
· Know what Medicare covers and what you have to pay


Medicare is here to help if you:
· Want to discuss your Medicare rights
· Have questions about Medicare benefits, services, and coverage
· Want to discuss billing issues

Order "Your Medicare Rights and Protections," a detailed list of your Medicare rights, by calling 1-800-MEDICARE (1-800-633-4227).


QUALITY OF CARE COMPLAINTS

If you are not receiving the care you need, you can file a quality of care complaint. Common quality of care complaints include wrong medication, unnecessary surgery or diagnostic testing, inadequate care or misdiagnosis by any Medicare hospital or doctor, and early discharge from a healthcare facility.

Medicare is here to help you. A team of medical experts will review your complaint and contact your provider regarding the quality of care you received.

Call 1-800-MEDICARE (1-800-633-4227)


If you would like to file a written complaint, call The Virgin Islands Medical Institute Beneficiary Helpline at (340)712-2444 to start the complaint process.


APPEALS
As a Medicare beneficiary, you have the right to appeal healthcare decisions that you disagree with. There are two types of appeals:

Hospital Discharge Appeals
File a Hospital Discharge Appeal if you believe you are not medically ready to go home from the hospital, or if you have not received clear discharge instructions.

Termination of Service Appeals
File a Termination of Service Appeal if you disagree with your healthcare provider's decision to terminate coverage from a nursing home, home health agency, or hospice.


If you would like to file an appeal, call The Virgin Islands Medical Institute Beneficiary Helpline at (340)712-2444 to start the process.



Other Beneficiary Protection Links
Senior Medicare Patrol Resource Center
"The Center serves as a bridge to facilitate sharing information, expertise, and experience between and among the SMPs. In addition, The Center provides general information for consumers on health care errors, fraud and abuse. The Center works to create an infrastructure that promotes sharing knowledge and best practices at the local level and provides an open community supportive of all SMPs, from novice to expert."
Medicare Initial Preventive Physical Examination Encounter Form  
"Dowload the Medicare Initial Preventive Physical Examination Encounter Form to take to your doctor"
Your Rights As A Hospital Patient  
"This document explains the rights of beneficiaries who are hospitalized as patients"
Your Medicare Rights and Protections  
"This booklet has information that beneficiaries and advocates need to know in order to file a complaint, appeal or identify where to go to get help with questions."

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