Streamline and Simplify Appeals Processes

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Improve Pharmacy Counter Communications with Beneficiaries

Knowing why a prescription drug is denied at the pharmacy counter is critical to helping beneficiaries determine their next steps—whether it is working with their physician to secure an alternative […]

May 15th, 2015|Categories: 30 Medicare Goals, Streamline and Simplify Appeals Processes|

Improve Medicare Advantage and Part D Denial Notices

Among the most common calls to the Medicare Rights helpline are those from beneficiaries who were denied access to a health care service or prescription medication and don’t know how […]

May 14th, 2015|Categories: 30 Medicare Goals, Streamline and Simplify Appeals Processes|

Allow Independent Redeterminations

The first level of appeal following a plan’s initial decision must be a truly independent and good-faith effort to determine coverage eligibility. This would better ensure that plans are accurately […]

May 13th, 2015|Categories: 30 Medicare Goals, Streamline and Simplify Appeals Processes|

Improve Transparency, Data Collection, and Plan Oversight

All Part D appeals conversations are hampered by limited data and transparency in the process. Beneficiaries and advocates alike can struggle not only to track an individual’s specific claims, but […]

May 12th, 2015|Categories: 30 Medicare Goals, Streamline and Simplify Appeals Processes|

Allow Appeals on the Part D Specialty Tier

When medically necessary, people with Part D have the right to request that their plan allow them to pay less for high-cost medications when a similar, lower-cost medicine is available […]

May 11th, 2015|Categories: 30 Medicare Goals, Streamline and Simplify Appeals Processes|