Medicare Questions and Answers
A: Don't be afraid to talk with your doctor first. Most health care facilities also have an employee (such as a social worker or a patient advocate) to whom you can express your concerns. If you are still not satisfied, call NMMRA's beneficiary helpline at 1-800-663-6351 to request a quality of care review.
A: Discuss your concern with your doctor and the hospital staff, including the discharge planner or social worker. The Centers for Medicare & Medicaid Services (CMS) have always required hospitals to advise Medicare beneficiaries of their right to appeal their hospital discharge. The Important Message from Medicare has been revised and now informs Medicare beneficiaries of their rights, including discharge appeal rights. If you or your representative wish to appeal the discharge decision, contact NMMRA at 1-800-663-6351 and follow the directions to file an appeal. A representative from our affiliate, HealthInsight Nevada. will take your concerns and coordinate the review. The review will be performed by a New Mexico physician. You must call before midnight on the day of discharge.
A: NMMRA cannot review non-medical issues in hospitals or skilled nursing facilities. You should share these concerns with the administration at that facility. You can also contact the Health Facilities Licensing and Certification Bureau at 1-800-752-8649 or 1-800-445-6242 or the State Ombudsman Program at 1-800-432-2080.
A: NMMRA cannot review billing concerns. If you have questions about a hospital bill, the first place to call is the hospital billing office. If you are still confused, call 1-800-Medicare.
If you have questions about a bill from a doctor's office or other outpatient service, the first place to call is their billing office. If you are still confused, call 1-800-Medicare.
For Medicare Advantage members, call the health plan's customer service department.
A: Contact the Social Security Administration at 1-800-772-1213. They provide all information about enrolling in Medicare or replacing lost cards. They will also give you free information about what Medicare covers.
A: New Mexico Aging Disability Resource Center has people who can provide benefits counseling. They can be reached at 1-800-432-2080. They can provide information about applying for Medicaid (a state health insurance for low-income people) and deciding on a Medigap policy (Medicare supplement insurance that pays for what Medicare does not cover).
A: Seniors Saving Medicare, a program that is part of the New Mexico Aging and Long-Term Services Department, educates Medicare beneficiaries on ways to protect Medicare funding. Staff members respond to concerns about providers who perhaps have committed fraud against Medicare. The New Mexico Aging and Long-Term Services Department can be reached at 1-866-842-9230.