There is no cost for this. Under certain circumstances, which we discuss later, you can request an expedited or fast coverage decision or fast appeal of a coverage decision. 0 0 0 rg See the appropriate fax number on the top of the form for submission. endstream endobj 131 0 obj <>/Subtype/Form/Type/XObject>>stream V7^Vv^Y}' }%. Prior to 2022, Advantage Plans were extremely limited in this are of Maryland. If we say no to all or part of your Level 1 Appeal, you can go on to a Level 2 Appeal. EMC To get a fast track appeal you must meet both of the following requirements: If we process your request as a fast track appeal we mayneed extra time to gather information. Search for a Provider. Everyone, regardless of income or health, qualifies for Medicare Advantage Part C Plans! document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! Let's say you have a $150 annual benefit for "vision benefits." That means you can get a filling, caps, crowns etc. This is a fantastic way to make sure you get to the Doctor's office on time, without the need to park or deal with traffic. However, if for some reason your issue isnt settled to your satisfaction, there are formal steps you can take. endstream endobj 125 0 obj <>/Subtype/Form/Type/XObject>>stream 0 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. Starting in 2022, there will be four new companies to enter into the Eastern Shore counties. http://www.ltcombudsman.ny.gov/. f For more information contact ArchCare Advantage. 0 0 0 rg You are about to leave the Johns Hopkins Advantage MD website. If you choose to provide us with personal information by sending an email, or by filling out a form with your personal information and submitting it through our Web site, we use that information to respond to your message and to help us provide you with information or material that you request. 2.16 1.68 6.6 3.96 re Llame al 1 800-373-3177 (TTY: 711). Spanish. If your previous broker didn't tell you about this amazing rule, get a new broker! The selection of Eastern Shore Medicare Advantage Plans in Maryland were extremely limited until now with only 2 companies offering limited plans in only select counties. In this appeal, we review the coverage decision we made to check to see if we were following all of the rules properly. If this organization says no to your appeal, it means the organization agrees with our decision not to approve your request. 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. There are no costs for my services and you'll never pay extra for your insurance if you allow me to help you. 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. I can provide you with a Summary of Benefits for any Eastern Shore Medicare Advantage Plan, just email or call me. Some of the new Eastern Shore Medicare Advantage Plans will be offering an OTC benefit. Whole Health Assessment Form Whole Health Assessment (Online Form) PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. Submit one form unique to the member. 1 800-373-3177 (TTY: 711), 2020ArchCarethe Continuing Care Community of the Archdiocese of New York. You'll still be expected to may co-payments when you fill your meds, but there is no monthly premium due each month for the Part D coverage! Under certain circumstances you can request an expedited coverage decision which is also called a fast track appeal. A fast track appeal means that we will make a decision no later than72 hours after receiving the request. If we do not give you an answer within 72 hours (or by the end of the extended time period if we took extra days), we are required to automatically send your request on to Level 2 of the appeals process, where it will be reviewed by an independent organization. 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. If the dollar value of the coverage you are requesting is too low, you cannot make another appeal, and the decision at Level 2 is final. 112 0 obj <> endobj When you appeal a decision for the first time, this is called a Level 1 Appeal. EMC endstream endobj 120 0 obj <>/Subtype/Form/Type/XObject>>stream There are many more "extra benefits" that these plans may offer such as Part B give-backs, gym memberships, 24hr Nurse hotline, routine podiatry visits, telehealth visits and lifestyle meds such as Viagra (or the generic equivalent). Appointment of Representative Form English There are three ways to file an appeal for Part C medical services: Payment appeals are accepted only in writing. EMC Information on Coronavirus (COVID-19) At Advantage MD, we want to make sure you have accurate information, know what to expect, and are empowered to care for your own and your family's health. H23U0t.C=0agn`ghPe @F !C=33=3c=K hYo8WK N5q4Wl,7],&Efh4 S!*6"| -#0!'@-qD@)4,U`U"M}up"x#P$"d8@D 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. If you live on the Eastern Shore of Maryland call. To start your appeal, you, your doctor or your representative must contact our plan. endstream endobj 133 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Livanta BFCC-QIO Program To ensure fairness and prompt handling of your problems, each process has a set of rules, procedures and deadlines that must be followed by us and by you. You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you of our answer to your request for a coverage decision. These items are things like food pantry items (rice, beans, bread etc), band aids, creams, lotions, vitamins etc. endstream endobj 138 0 obj <>/Subtype/Form/Type/XObject>>stream 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. 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. 1.08 1.08 8.76 5.16 re You also have the right to ask for an expedited (fast) grievance. At Johns Hopkins HealthCare LLC (JHHC), we are committed to making it easy for providers to work with us. Johns Hopkins Enterprise Directory v.5.38.1. There's no cost to have the coverage (it's included in your monthly plan premium) but there are typically small co-payments or co-insurance amounts that you will be responsible for. You or your appointed legal representative may file a grievance. Others may already be authorized under state law to act for you. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. EMC If you have any of these problems, you may file a grievance: If you would like to file a grievance, please call ArchCare Advantage Customer Service Department first at 18003733177 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m., fax us at (917) 398-1719, or mail us at ArchCare Advantage, Attention: Grievance Dept., 205 Lexington Avenue, 8th Floor New York, NY 10016. Your appeal is handled by different reviewers than those who made the original unfavorable decision. hbbd```b``. Personally Provided Information If you have questions about ending your membership with Johns Hopkins Advantage MD, please call us . When we have completed the review, we give you our decision. Send this form with supporting documentation, to: Johns Hopkins Advantage MD Payment Disputes, P.O. You can look through their catalog of items and order online or by phone. endstream endobj 134 0 obj <>/Subtype/Form/Type/XObject>>stream Benefits, formulary, pharmacy network, premium and/ or co-payments/co-insurance may change on January 1 of each year. 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. All you need is Medicare parts A & B and live in one of the counties serviced by the plan. In other situations, you will need to ask for a Level 2 Appeal). Our denial of your request to expedite acoverage decisionor reconsideration for health services. These instructions will tell who can make this Level 2 Appeal, what deadlines you must followand how to reach the review organization. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. You may name someone to act for you as a representative for filing an appeal or grievance. If you disagree with a service/coverage determination we have made, you need to use the process for filing appeals. 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. /Tx BMC Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. See your Evidence of Coverage for more specific information on how to end your membership. The only requirement is that you make a reservation in advance, usually 24 hours, and they limit your distance, typically 50 miles one-way or less. 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. Chapter 9 of your plans EOC will provide more specific information about our process for appeals, grievances, and coverage decisions. You can reach out to the office of Johns Hopkins Pharmaquip Inc via phone at, 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224, Durable Medical Equipment & Medical Supplies Supplier, 5901 Holabird Ave, Suite A, Baltimore, MD 21224, 5901 Holabird Avenue, Suite A, Baltimore, MD 21224, DME Supplier - Oxygen Equipment & Supplies, Blood Glucose Monitors & Supplies: Non-Mail Order, CPAP, RADs, & Related Supplies & Accessories, High Frequency Chest Wall Oscillation (HFCWO) Devices, Infusion Pumps & Supplies: External Infusion, Support Surfaces: Pressure Reducing Beds, Mattresses, Overlays, & Pads, Transcutaneous Electrical Nerve Stimulators (TENS) Units, Wheelchairs & Accessories: Standard Manual, Wheelchairs & Accessories: Standard Power. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. 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. If you have questions about the appeals process or would like to know the status of an appeal youve filed, please call us. I've seen savings as high as 70% using this type of benefit. 0 0 0 rg A typically hearing benefit might be a free hearing exam annually, or deeply discounted pricing on select hearing aids. The formal name for making a complaint is filing a grievance. The complaint process is used for certain types of problems only. 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. It's the 5th option down on the page. 1.08 1.08 8.76 5.16 re Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Ending your membership in Johns Hopkins Advantage MD may be voluntary (your own choice) or involuntary (not your own choice): If you are voluntarily ending your membership, there are only certain times during the year, or certain situations, when you may do so. 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. I look forward to helping you! If we do not give you an answer by the deadline above (or by the end of the extended time period if we took extra days), we are required to send your request on to Level 2 of the appeals process, where it will be reviewed by an independent outside organization. We will give you our decision sooner if your health condition requires us to. Medicare Reconsideration Request (CMS-20033) What's it used for? Wrong. ALTERWOOD ADVANTAGE: Somerset, Wicomico, Worcester, Caroline, Cecil, Dorchester, Kent, Queen Annes, and Talbot. View recent announcements. You can also contact Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, seven days a week. "MMnE@UH[ )-@ =$! There are Medicare Advantage Plans on the Eastern Shore that include both preventative and comprehensive dental coverage. You can file a grievance or someone you authorize can do so on your behalf. We honor your rights, take your problems and concerns seriously, and treat you with fairness and respect. 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. Yorb Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Your privacy is important to us. You can only end your membership with Johns Hopkins Advantage MD during certain times of the year. EMC Here are some common "extra benefits" that may be included in your Medicare Advantage Plan (varies by carrier & plan): DRUG COVERAGE - All MAPD Plans include Rx coverage built in (you don't pay extra for the coverage). endstream endobj startxref Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). If you are asking for a fast appeal,you may make your appeal in writing or by calling us at the number listed below. endstream endobj 128 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 129 0 obj <>/Subtype/Form/Type/XObject>>stream If you are asking for a standard appeal, make your appeal by submitting a written request. EMC f Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. 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. Enrolling is quick and easy. Baltimore Johns Hopkins Pharmaquip Inc is a medicare enrolled Durable Medical Equipment & Medical Supplies Supplier in Baltimore, Maryland. 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. With useful Medicare information delivered right to your inbox. Your complaint must be filed within 60 days of the event or incident. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. This information is available for free in other languages. If we extend the time, you will receive notification from the plan. If the dollar value of the coverage you are requesting meets the requirement, you choose whether you want to take your appeal further. EMC This organization decides whether the decision we made should be changed. The exception forms can be submitted online, by fax, or by mail. 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. EMC /Tx BMC It is located at 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224. Box 3537, Scranton, PA 18505. Box3538, Scranton, PA 18505. However, if you ask for more time, or if we need to gather more information that may benefit you, we can take up to 14 more calendar days. If you need help filling out the form or want to learn more about appointing a representative, you can call us at 18003733177 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m. Fax us at (646) 417-7167, or mail us at ArchCare Advantage, Attention: Appeals Dept., 205 Lexington Avenue, 8th Floor New York, NY 10016. There are three additional levels in the appeals process after Level 2, for a total of five levels of appeal. If we make a coverage decision that you are not satisfied with, you can appeal the decision. They include (but are not limited to): formulary exceptions, step therapy exceptions, and tier exceptions. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. /Tx BMC We may extend the time frame by up to 14 days if you ask for an extension, or if we identify a need for additional information and the delay is in your best interest. The Medicare Advantage Open Enrollment period is from January 1 to March 31. This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care. H23U0t.C=0agn`ghPe @F !C=33=3c=K You can reach out to the office of Johns Hopkins Pharmaquip Inc via phone at (410) 288-8036. If we decide to take extra days to make the decision, we will tell you in writing. You must have JavaScript enabled to use this form. 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) Benefit levels vary by plan. endstream endobj 127 0 obj <>/Subtype/Form/Type/XObject>>stream 2.16 1.68 6.6 3.96 re 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. Advantage MD Participating Provider Post-Service Payment Dispute Form This form should be completed within 90 days of notification of denial (remittance). If you have a fast complaint it means we will give you an answer within 24 hours. If we agree with your grievance, then we will cancel the 14-day extension and expedite the determination or appeal as you originally requested. From April 1September 30, you will need to leave a message on weekends and holidays. endstream endobj 137 0 obj <>/Subtype/Form/Type/XObject>>stream Please note that by clicking Request Information, I expressly, give permission for a sales agent from an ArchCare Medicare. endstream endobj 119 0 obj <>/Subtype/Form/Type/XObject>>stream Your appeal is handled by different reviewers than those who make the original decision. Our mailing address and fax number are on the second page of the form. A Quality of Care Complaint may be filed through the standard grievance process outline above. Your membership will end on the first day of the month after we get your request to switch to Original Medicare. /Tx BMC They give you a set dollar amount to spend each quarter, like $25. For more information, see the section titled Chapter 9. (To keep things simple, we use coverage decision rather than organization determination.) If the plan denies coverage for your requested item or service, you have the right to appeal and ask us to reconsider the decision. If you are using a screen reader and need to increase the timeout length to avoid timing out, then click to follow this link to the change timeout page in order to change your timeout length to avoid timeouts. Enrollment in ArchCare Advantage depends on contract renewal. 2023 Part D Coverage Determinations and Appeals, 2022 Part D Coverage Determinations and Appeals, 2023 Medication Therapy Management Program, 2022 Medication Therapy Management Program, I would like a representative to call me to speak about questions regarding enrolling inaplan, Receipt of, or payment for, a care item or service, The amount you pay for an item or service, A limit on the quantity of items or services, You are asking for coverage for medical care you have not yet received, Using the standard deadlines could cause serious harm to your health or hurt your ability to function. I want to. The Independent Review Organization is an independent organization that is hired by Medicare. /Tx BMC Discrimination is Against the Law =`r&wH0dPU|0y,~L8w>da8fg"%`v' Any carrier that offers this service must make available all types of transportation to facilitate those with special needs, such as walkers, wheel chairs or those requiring a gurney. ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. As a member of Johns Hopkins Advantage MD, you have a right to request an organization determination. If there is anything else you need to do, we will let you know. If we make a coverage decision and you are not satisfied with this decision, you can appeal the decision. 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. By fax: Fax the completed Redetermination Request Form within sixty (60) days from the date of the notice of coverage determination to 18556337673. HMO members: 877-293-4998 (TTY:711). You may already have someone authorized by the Court or in accordance with State law to act for you. 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. The Annual Enrollment Period (AEP), which happens from October 15 to December 7. 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
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