WHAT IS MEDICARE?
Medicare is a Federal Health Insurance Program for people age 65 or older and for certain disabled persons. Medicare pays for medical care that is necessary and provided in the most appropriate location (doctor’s office, hospital, etc.) To enroll in Medicare, you should contact your local social security office.
WHAT IS THE MEDICARE PEER REVIEW ORGANIZATION?
Medicare Peer Review Organization (PROs) are practicing doctors and other health care professionals, contracted and paid by the federal government to monitor the care given to Medicare recipients. Each state has a PRO. PROs have the authority to decide whether care given to Medicare recipients is reasonable and necessary, is provided in the most appropriate setting, and meets standards of quality generally accepted by the medical profession. Florida Medical Quality Assurance, Inc. (FMQAI) is the Medicare PRO in Florida. Please call FMQAI with concerns and questions regarding your Medicare rights at: 1-800-844-0795.
WHAT ARE MY MEDICARE RIGHTS?
As a Medicare recipient, whether you have traditional (Fee-for-Service) Medicare or are a member of a Medicare Health Maintenance Organization (HMO), you have many rights. Your Medicare rights include:
The right to receive quality medical care based on acceptable medical standards.
The right to be fully informed about your health care.
The right to receive all medical care that is: necessary and appropriate for the proper diagnosis and treatment of your illness or injury (your hospital stay is to be based on medical need, not payment to the hospital).
The right to be fully informed about decisions affecting your Medicare coverage and payment for your hospital stay and for any post-hospital services.
The right to appeal, through the Medicare PRO, any written notices stating that Medicare will no longer pay for your hospital stay.
WHAT SHOULD I DO IF I FEEL I DID NOT RECEIVE QUALITY MEDICAL CARE?
If you feel you did not receive quality care in a hospital (inpatient or outpatient), ambulatory surgery center, skilled nursing facility, home health agency, HMO or HMO physician office visit, you may send a written complaint to your Medicare PRO at the following address:
Florida Medical Quality Assurance, Inc.
4350 West Cypress Street, Suite 900, Tampa, FL 33607-4151 Or call: 1-800-844-0795
FREE MEDICARE SPEAKERS
Your Medicare PRO, FMQAI, offers free speakers to talk to your group or organization about the rights of Medicare recipients. Please contact the Communications Department to schedule a presentation at: 1-800-844-0795 toll-free in Florida - (813) 354-9111 in Tampa
WHAT SHOULD I DO IF I AM ASKED TO LEAVE THE HOSPITAL BEFORE I FEEL READY?
Whether you are a Fee-for-Service Medicare recipient or are a member of an HMO, you should:
Discuss your concerns with your physician, patient representative or discharge planner.
Ask for a written statement….
A Hospital-Issued Notice of Noncoverage
….telling you when you will be responsible for the bill if you choose to remain in the hospital.
As a Medicare recipient (Fee-for-Service or HMO), you may appeal the discharge by immediately calling your Medicare PRO at 1-800-844-0795 (Monday — Friday, 8 a.m. — 5 p.m. EST in English and Spanish) for a priority review. In many instances, Medicare may continue to pay during the review.
UNDERSTANDING YOUR MEDICARE LANGUAGE
Medicare Part A
Federal hospital insurance which pays for part of inpatient hospital care, skilled nursing facility care, home health care and hospice care through the Fiscal Intermediary (FI). The FIs in Florida are Aetna (813) 796-8292, Mutual of Omaha (402) 351-2860, and Blue Cross/Blue Shield (the largest FI in Florida) 1-800-333-7586 in Florida or (904) 355-8899 out-of-state).
Medicare Part B
Federal medical insurance which pays for part of doctors’ services, hospital outpatient services, home health care and other services and supplies not covered by Part A. Call 1-800-333-7586 in Florida or (904) 355-3680 out-of-state.
Important Message from Medicare
If you are admitted to a Medicare participating hospital, you will receive An Important Message from Medicare which explains your rights as a hospital patient and provides the name, address and phone number of the Medicare PRO.
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
FREE INSURANCE HELP
The State of Florida Department of Elder Affairs program, "Serving the Health Insurance Needs of the Elderly" (SHINE), offers free health insurance counseling to Medicare recipients and other elders in Florida. SHINE volunteers counsel and provide information regarding health insurance issues. For more information about SHINE, please call (904) 414-2060.
