If you do so, your membership will end when your new plans coverage begins on January 1. FAX 855-206-9206. Benefits, formulary, pharmacy network, premium and/ or co-payments/co-insurance may change on January 1 of each year. You or your appointed legal representative may file a grievance. Discrimination is Against the Law 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. H23U0t.C=0agn`ghPe @F !C=33=3c=K 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. 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. /Tx BMC If your health requires it, ask for a fast appeal.If we are using the fast deadlines, we will give you our answer within 72 hours after we receive your Part C (Medical) or Part D (prescription drug) appeal. If you wish, you can complain to us and the QIO at the same time. Send this form with supporting documentation, to: Johns Hopkins Advantage MD Payment Disputes, P.O. Chapter 9 of the Evidence of Coverage Determinations has more information about Levels 3, 4and 5 of the appeals process. If we say no to your Level 1 Appeal, the written notice we send you will include instructions on how to make a Level 2 Appeal with the Independent Review Organization. 156 0 obj <>/Filter/FlateDecode/ID[]/Index[112 85]/Info 111 0 R/Length 127/Prev 82147/Root 113 0 R/Size 197/Type/XRef/W[1 3 1]>>stream There are no costs for my services and you'll never pay extra for your insurance if you allow me to help you. VISION - Vision benefits are not the same as being able to access a specialist like an ophthalmologist, those visits are always covered by Medicare, as long as it's medically necessary. Others may already be authorized under state law to act for you. Contact JHHC. https://medicare.gov/medicarecomplaintform/home.aspx HUMANA LPPO: Caroline, Cecil, Dorchester, Kent, Queen Annes, and Talbot. endstream endobj 142 0 obj <>stream Contact Us | Johns Hopkins Advantage MD - hopkinsmedicare.com Your health and satisfaction are important to us. You have the right to request a fast grievance if you disagree with: Upon receipt of the grievance, we will promptly investigate the issue you have identified. At Johns Hopkins HealthCare LLC (JHHC), we are committed to making it easy for providers to work with us. f Johns Hopkins Advantage MD Appeals and Grievances, P.O. In this appeal, we review the coverage decision we made to check to see if we were following all of the rules properly. When you have a problem or concern, please call ArchCare Advantage Customer Service Department first at 18003733177 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m. Our customer service staff will work with you to try to find a satisfactory solution to your problem. Some of the new Eastern Shore Medicare Advantage Plans will be offering an OTC benefit. This person can be a relative, friend, lawyer, advocate, doctor or someone else. This organization is not connected with us, and it is not a government agency. Livanta BFCC-QIO Program endstream endobj 131 0 obj <>/Subtype/Form/Type/XObject>>stream Contact us promptly either by phone or in writing. /Tx BMC EMC Johns Hopkins to drop its Medicare supplement plans for Baltimore City /Tx BMC endstream endobj 130 0 obj <>/Subtype/Form/Type/XObject>>stream There are three ways to file an appeal for Part C medical services: Payment appeals are accepted only in writing. If you have a fast complaint it means we will give you an answer within 24 hours. What typically sets Advantage Plans apart are these little "extra" benefits found in the Summary of Benefits. They include (but are not limited to): formulary exceptions, step therapy exceptions, and tier exceptions. Eligible beneficiaries may enroll in our plan at any time of year. If we end your membership in our plan, we will tell you our reasons in writing for ending your membership and tell you how you can make a complaint about our decision to end your membership. To request a coverage decision regarding medical care you or your representative may: We are available 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 members:877-293-5325 (TTY: 711) Call me to discuss this option. We will give you our decision sooner if your health condition requires us to. Member Resources - Johns Hopkins Employer Health Programs (EHP) The items ship for free. Let's say you have a $150 annual benefit for "vision benefits." Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. You may name a relative, friend, attorney, doctor or someone else to act for you. If you are asking for a standard appeal, make your appeal by submitting a written request. Box 3537, Scranton, PA 18505. Johns Hopkins Medicare Advantage - Maryland Medicare Options If we say no to all or part of your Level 1 Appeal, you can go on to a Level 2 Appeal. 10,000+ Maryland Providers Variety of Medicare Plans Advantage MD Care Team Johns Hopkins Advantage MD | Maryland Medicare Advantage Plan Johns Hopkins Advantage MD D-SNP (HMO) Formularies Cost Sharing Tiers Prior Authorization, Quantity Limits, and Step Therapy Select Insulins for Reduced Copays - New 2022 Benefit Exceptions Appeals (Redetermination) Opioid Edits Medical Injectables Over the Counter Program - New 2022 Benefit Advantage MD Pharmacy Formularies In other situations, you will need to ask for a Level 2 Appeal). They give you a set dollar amount to spend each quarter, like $25. TRANSPORTATION - Some of the new plans offer free transportation (door-to-door) to plan approved locations. The exception forms can be submitted online, by fax, or by mail. 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. Wpt.$1#NPq$##?LwA7sYt||V$it\=-f-7H 5YR`mym6h[av=tnz]OoE.Z-xkZ The benefit information provided herein is a brief summary, not a comprehensive description of benefits. If we decide to take extra days to make the decision, we will tell you in writing. If you are leaving our plan, you must continue to get your medical care and prescription drugs through our plan until your membership ends. The formal name for making a complaint is filing a grievance. The complaint process is used for certain types of problems only. Enrollment in ArchCare Advantage depends on contract renewal. 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. The notice you get from the Independent Review Organization will tell you the dollar value that must be in dispute to continue with the appeals process. Privacy Practices Terms & Conditions Accessibility Interoperability Medicare.gov, Notice of Nondiscrimination: Appeals & Grievances | Johns Hopkins Advantage MD Advantage MD Participating Provider Post-Service Payment Dispute Form This form should be completed within 90 days of notification of denial (remittance). You also have the right to ask for an expedited (fast) grievance. Under certain circumstances, which we discuss later, you can request an expedited or fast coverage decision or fast appeal of a coverage decision. If you believe your health requires it, you should ask for fast appeal.In some cases, such as when additional information is neededand it is in your best interest to extend the time frame of our response, we may extend the time up to 14 days. It is located at 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224. Pharmacy & Formulary - Hopkins Medicine 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. /Tx BMC To authorize someone to act as your representative, you and that person must sign and date a statement that gives the person legal permission to do so. Today, with Advantage MD you get a choice of Medicare plans to meet your needs - offering quality benefits, built-in savings, expert care and more. These instructions will tell who can make this Level 2 Appeal, what deadlines you must followand how to reach the review organization. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. You are about to leave the Johns Hopkins Advantage MD website. EMC /Tx BMC Requesting a 2nd appeal (reconsideration) if you're not satisfied with the outcome of your first appeal. f ACUPUNCTURE - I'm personally not a fan, but I know millions of people love their Acupuncture. 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 $150 of the purchase is covered by the Eastern Shore Medicare Advantage Plan. =`r&wH0dPU|0y,~L8w>da8fg"%`v' Claims - Hopkins Medicine Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. ArchCare Advantage HMO SNP is a Coordinated Care Plan with a Medicare contract. hYo8WK N5q4Wl,7],&Efh4 S!*6"| -#0!'@-qD@)4,U`U"M}up"x#P$"d8@D Requesting an appeal (redetermination) if you disagree with Medicare's coverage or payment decision. Box3538, Scranton, PA 18505. Submit one form unique to the member. Stress Relief - September 15 - Johns Hopkins Advantage MD This information is available for free in other languages. TTY users can call 711. If you live on the Eastern Shore of Maryland call. That means you don't pay anything for simple preventative procedures like cleanings and oral exams. UNITED HEALTHCARE DSNP: Caroline, Cecil, Dorchester, Kent, Queen Annes, and Talbot. EMC Provider Resources | Johns Hopkins Advantage MD When you have a problem or concern, please call ArchCare Advantage Customer Service Department first at 18003733177 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m. Our customer service staff will work with you to try to find a satisfactory solution to your problem. We will give you our answer sooner if your health requires us to do so. Our staff will work with you to try to find a satisfactory solution to your problem. If we are using the standard deadlines, we will give you our answer within seven calendar days after we receive your Part D (prescription drug) appealor within 30 calendar days after we receive your Part C (Medical) appeal.
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