What is a Medicare Beneficiary Ombudsman?

By Daniel Petkevich

Apr 11, 2023

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If you want to make an appeal or lodge a complaint, talk to your MBO

What is a Medicare Ombudsman?

• Helping Medicare beneficiaries navigate the system and respond to issues related to coverage, claims, and billing
• Providing information about your Medicare benefits, rights, and protections
• Helping beneficiaries file complaints and appeals related to their Medicare services and coverage
• Educating Medicare beneficiaries about fraud and abuse in Medicare, including strategies about how to protect yourself

Why would I need to contact a Medicare Ombudsman?

• You are having difficulty accessing the healthcare services or treatments you need.
• You are experiencing delays or denials in getting Medicare coverage for a particular service or treatment.
• You are dissatisfied with the quality of care you are receiving from a healthcare provider or facility.
• You have concerns about the accuracy of your Medicare claims or bills.
• You are having difficulty navigating the Medicare system and need assistance with enrollment or understanding your benefits.

• Denials of coverage for medically necessary services or treatments
• Delays or denials in receiving prescription drugs or durable medical equipment
• Billing errors or disputes
• Quality of care issues, such as hospital infections or medical errors
• Issues related to Medicare Advantage or prescription drug plans
• Complaints about Medicare marketing or enrollment practices
• Difficulty navigating the Medicare system or understanding your benefits

How to contact a Medicare Ombudsman

What to expect when contacting a Medicare Ombudsman

Tips for preparing to contact Medicare Ombudsman

1. Gather information: Before contacting the Medicare Ombudsman, gather relevant information about your issue, such as medical bills or correspondence from your healthcare providers. Having this information on hand can help the Ombudsman better understand your situation and advocate on your behalf.
2. Be proactive: The Medicare Ombudsman is there to assist you, but it's important to be proactive in your approach. No one will be a better advocate for you than yourself. If you have questions or concerns about the process or timeline, ask for clarification. If you think there may be additional information that could be helpful, offer to provide it. Being proactive can help ensure that your issue or complaint is resolved as quickly and efficiently as possible.
3. Take notes: Keep a record of all correspondence and interactions with the Medicare Ombudsman, including dates, times, and the names of the people you speak with. This can help you keep track of the progress of your case and provide a reference in case you need to follow up.
4. Follow up: After your interaction with the Medicare Ombudsman, follow up if necessary. If you have additional questions or concerns, don't hesitate to contact them again. Keep in mind that the Ombudsman is there to assist you, and they want to ensure that your issue or complaint is resolved to your satisfaction.

Conclusion