We will give you our answer sooner if your health requires us to do so. An appeal is a formal way of asking us to review and change a decision we have made. hYo8WK N5q4Wl,7],&Efh4 S!*6"| -#0!'@-qD@)4,U`U"M}up"x#P$"d8@D 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. What if the review organization says no to your appeal? If we make a coverage decision and you are not satisfied with this decision, you can appeal the decision. /Tx BMC endstream endobj 113 0 obj <>/Metadata 3 0 R/Pages 110 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 114 0 obj <>/MediaBox[0 0 612 792]/Parent 110 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 115 0 obj <>/Subtype/Form/Type/XObject>>stream V7^Vv^Y}' }%. This field is for validation purposes and should be left unchanged. You can file a grievance or someone you authorize can do so on your behalf. Others may already be authorized under state law to act for you. We will give you our answer sooner if your health requires it. How this typically works is you access a network of acupuncturist (your plan will provide you with a link to search) and you simply self-refer to one. You also have a right to file a grievance (also called a complaint) about the health plan. Everyone, regardless of income or health, qualifies for Medicare Advantage Part C Plans! ALTERWOOD ADVANTAGE: Somerset, Wicomico, Worcester, Caroline, Cecil, Dorchester, Kent, Queen Annes, and Talbot. f This person can be a relative, friend, lawyer, advocate, doctor or someone else. A Quality of Care Complaint may be filed through the standard grievance process outline above. What to do if you have a problem or complaint (coverage decisions, appeals, complaints) in the Evidence of Coverage. /Tx BMC We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your grievance. Eligible beneficiaries may enroll in our plan at any time of year. If you decide to go on to a Level 2 Appeal, the Independent Review Organization reviews the decision we made when we said no to your first appeal. If we decide to take extra days to make the decision, we will tell you in writing. These items are things like food pantry items (rice, beans, bread etc), band aids, creams, lotions, vitamins etc. I can provide you with a Summary of Benefits for any Eastern Shore Medicare Advantage Plan, just email or call me. Part D Exception Request Forms Prior Authorization/Utilization Management Form This organization is not connected with us, and it is not a government agency. Sometimes a plan will mingle the two together, giving you 20 visits between the two types of alternative medicine services per year, and you get to choose which one you'll go to (you can mix-n-match). You or your appointed legal representative may file a grievance. 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. Box 3538 Scranton, PA 18505 Medicare Compliance Department Contact Information Johns Hopkins HealthCare has a Compliance Department Division dedicated to Johns Hopkins Advantage MD. Appointment of Representative Form Spanish. 0 0 0 rg 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 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. If we are using standard deadlines, we must give you our answer within 30 calendar days after we receive your appeal if your appeal is about coverage for services you have not yet received. Box 8777, Elkridge, MD 21075. It is located at 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224. Starting in 2022, there will be four new companies to enter into the Eastern Shore counties. See your Evidence of Coverage for more specific information on how to end your membership. Box 3507, Scranton, PA 18505. Please note that by clicking Request Information, I expressly, give permission for a sales agent from an ArchCare Medicare. Yorb Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. /Tx BMC 0.5 0.5 0.5 rg Enrolling is quick and easy. You may submit feedback about ArchCare Advantage directly to Medicare or the NYS Office of Long-Term Care Ombudsman Program using the links below. If you do so, your membership will end when your new plans coverage begins on January 1. 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. How do I get help from this form? If you disagree with a service/coverage determination we have made, you need to use the process for filing appeals. In fact, I work with a very large Medicare Supplement carrier (I promise you've heard of them) that will give you 24 months to "test" a Medicare Advantage plan, and they will approve your Medicare Supplement application at anytime, with NO MEDICAL QUESTIONS, within that 24 months! The formal name for making a complaint is filing a grievance. A grievance is a type of complaint you make about the health plan or one of our network providers, including a complaint concerning the quality of your care. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. You are unhappy with the cleanliness or condition of a hospital, doctors office or pharmacy. endstream endobj 128 0 obj <>/Subtype/Form/Type/XObject>>stream If you live on the Eastern Shore of Maryland call. EMC VISION - Vision benefits are not the same as being able to access a specialist like an ophthalmologist, those visits are always covered by Medicare, as long as it's medically necessary. 1.08 1.08 8.76 5.16 re I look forward to helping you! 2.16 1.68 6.6 3.96 re We honor your rights, take your problems and concerns seriously, and treat you with fairness and respect. For all grievances, you will receive a written notice stating the results of the review. You must continue to pay your Medicare Part B premium. In this appeal, we review the coverage decision we made to check to see if we were following all of the rules properly. endstream endobj 142 0 obj <>stream If you are asking for a standard appeal, make your appeal by submitting a written request. /Tx BMC Since 2011, I've been an independent Medicare insurance broker. endstream endobj 126 0 obj <>/Subtype/Form/Type/XObject>>stream You may access the appointment of representative form. There are some situations where you would be required to leave the plan, such as if you move out of the Johns Hopkins Advantage MD service area; you do not pay your required plan premium; or if Johns Hopkins Advantage MD leaves the Medicare program. 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. endstream endobj 139 0 obj <>/Subtype/Form/Type/XObject>>stream Baltimore Johns Hopkins Pharmaquip Inc is a medicare enrolled Durable Medical Equipment & Medical Supplies Supplier in Baltimore, Maryland. EMC 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. Johns Hopkins is terminating its Advantage MD plans for Medicare-eligible Baltimore City residents, forcing over 5,000 seniors to look elsewhere for reduced prescription drug prices and reasonable co-pays during the Covid pandemic. After you file your complaint, we will investigate it. For specific instructions on how to file an appeal, you or your representative may: NEW: Johns Hopkins Advantage MD Appeals, P.O. If we extend the time, you will receive notification from the plan. You can look through their catalog of items and order online or by phone. Look up plan benefits. Wpt.$1#NPq$##?LwA7sYt||V$it\=-f-7H 5YR`mym6h[av=tnz]OoE.Z-xkZ You may download the appointment of representative form. 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 believe that someone did not respect your right to privacy or shared information you feel should be confidential. This page was last updated: September 30, 2022 at 9:12 pm EST. Use of the Johns Hopkins Enterprise Directory (JHED) Computer System, shall be solely for the business purposes of the Johns Hopkins I If you have a fast complaint it means we will give you an answer within 24 hours. To authorize someone to act as your representative, you and that person must sign and date a statement that gives the person legal permission to do so. H23U0t.C=0agn`ghPe @F !C=33=3c=K If you believe your health requires it, you should ask for fast appeal.In some cases, such as when additional information is neededand it is in your best interest to extend the time frame of our response, we may extend the time up to 14 days. Requesting an appeal (redetermination) if you disagree with Medicare's coverage or payment decision. If you have questions about ending your membership with Johns Hopkins Advantage MD, please call us . Our mailing address and fax number are on the second page of the form. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. without needing any extra dental insurance coverage. To request a coverage decision regarding payment requests you or your representative may: Johns Hopkins Advantage MD, PO BOX 3537, Scranton, PA 18505. You may already have someone authorized by the Court or in accordance with State law to act for you. Our staff will work with you to try to find a satisfactory solution to your problem. Call me to discuss this option. ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Some of the new Eastern Shore Medicare Advantage Plans will be offering an OTC benefit. If you believe we should not take extra days, you can file an expedited or fast grievance also known as a fast complaint.See the grievance process below for more information about the grievance process. What we mean by "vision benefits" are the extras, like a free or low-cost annual vision exam or money towards the purchase of new lenses or frames. Review quality measures. 2.16 1.68 6.6 3.96 re We will give you our decision sooner if you have not received the drug yet and your health condition requires us to do so. If you decide to make a third appeal, the details on how to do this are in the written notice you got after your second appeal. For more information contact ArchCare Advantage. 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. EMC Enrollment in ArchCare Advantage depends on contract renewal. EMC /Tx BMC This organization decides whether the decision we made should be changed. endstream endobj 133 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg ACUPUNCTURE - I'm personally not a fan, but I know millions of people love their Acupuncture. Benefits, formulary, pharmacy network, premium and/ or co-payments/co-insurance may change on January 1 of each year. When you appeal a decision for the first time, this is called a Level 1 Appeal. You will probably have a small co-payment, usually $20 per visit, and you will be limited to a certain amount of visits per year, typically 6 to 12. Box 3538, Scranton, PA 18505 Or fax to: 855-206-9203 File a Complaint with Medicare You can also submit a complaint about your Medicare health plan or prescription drug plan directly to Medicare. If you are not satisfied with the decision at the Level 2 Appeal, you may be able to continue through additional levels of appeal. Alterwood Advantage is a brand new company for 2022 and has some amazing plan offerings throughout Maryland. 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. endstream endobj 127 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 121 0 obj <>/Subtype/Form/Type/XObject>>stream When we have completed the review, we give you our decision. 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. HUMANA LPPO: Caroline, Cecil, Dorchester, Kent, Queen Annes, and Talbot. Box3538, Scranton, PA 18505. Johns Hopkins Pharmaquip Inc is a medicare enrolled Durable Medical Equipment & Medical Supplies Supplier in Baltimore, Maryland. If there is anything else you need to do, we will let you know. /Tx BMC You can also submit a complaint about your Medicare health plan or prescription drug plan directly to Medicare. EMC An appeal is a formal way of asking the plan to review and change a coverage decision we have made. The Independent Review Organization is an independent organization that is hired by Medicare. %PDF-1.6 % Chapter 9 of your plans EOC will provide more specific information about our process for appeals, grievances, and coverage decisions. 2.16 1.68 6.6 3.96 re Contact JHHC. TTY users should call 877-486-2048. CAREFIRSThas announced an expansion over the bridge into three Eastern Shore counties of Somerset, Wicomico and Worcester. TTY users can call 711. Welcome Advantage MD Members. 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. 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). The Level 3 Appeal is handled by an administrative law judge. You must have JavaScript enabled to use this form. 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. Give us a call (410) 896-1212. Your appeal is handled by different reviewers than those who made the original unfavorable decision. 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. Prior to 2022, Advantage Plans were extremely limited in this are of Maryland. 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. endstream endobj startxref You also have a right to file a grievance (also called a complaint) about the health plan. What typically sets Advantage Plans apart are these little "extra" benefits found in the Summary of Benefits. Read more about coronavirus. To request a coverage decision regarding medical care you or your representative may: 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) 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. However, if for some reason your issue isnt settled to your satisfaction, there are formal steps you can take. If we make a coverage decision that you are not satisfied with, you can appeal the decision. You are about to leave the Johns Hopkins Advantage MD website. f 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. 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. endstream endobj 136 0 obj <>/Subtype/Form/Type/XObject>>stream 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. The balance is your responsibility, but that's still an amazing deal! By fax: Fax the completed Redetermination Request Form within sixty (60) days from the date of the notice of coverage determination to 18556337673. 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. It is located at 5901 Holabird Ave, Ste A, Baltimore, Maryland 21224. 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). You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for coverage decision. endstream endobj 137 0 obj <>/Subtype/Form/Type/XObject>>stream The formal name for making a complaint is filing a grievance. The complaint process is used for certain types of problems only. DID YOU KNOW? The Annual Enrollment Period (AEP), which happens from October 15 to December 7. However, if you ask for more time, or we need to gather more information that may benefit you, we can take up to 14 more calendar days. With a dedicated claims department, you can be assured that your claims will be handled quickly and accurately. View recent announcements. Request a 2nd appeal What's the form called? Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. Search for a Provider. 0.5 0.5 0.5 rg If the dollar value of the coverage you are requesting meets the requirement, you choose whether you want to take your appeal further. 8 a.m.-8 p.m., 7 days a week. There are Medicare Advantage Plans on the Eastern Shore that include both preventative and comprehensive dental coverage. 0.5 0.5 0.5 rg f You have rights as a member of our plan and as someone who is receiving Medicare. All you need is Medicare parts A & B and live in one of the counties serviced by the plan. Limitations, copayments and restrictions may apply. This organization is a company chosen by Medicare to review our decisions about your benefits with us. By mail: If you wish to file a standard appeal, you must send written request within sixty (60) days from the date of the notice of coverage determination to: CVS Caremark Part D Services, MC109, PO Box 52066, Phoenix, AZ 85072-2066. Likewise, if you are a caregiver for an Advantage MD member, the member must provide authorization for Advantage MD to speak with you. =`r&wH0dPU|0y,~L8w>da8fg"%`v' The exception forms can be submitted online, by fax, or by mail. Johns Hopkins Advantage MD D-SNP (HMO) Formularies Cost Sharing Tiers Prior Authorization, Quantity Limits, and Step Therapy Select Insulins for Reduced Copays - New 2022 Benefit Exceptions Appeals (Redetermination) Opioid Edits Medical Injectables Over the Counter Program - New 2022 Benefit Advantage MD Pharmacy Formularies 0 It's the 5th option down on the page. Send this form with supporting documentation, to: Johns Hopkins Advantage MD Payment Disputes, P.O. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal. 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. If this happens, we will let you know. Benefit levels vary by plan. Online Medicare Complaint Form The Office of the Medicare Ombudsman can also help you with complaints and grievances. OVER THE COUNTER ITEMS - Any item you can buy in a CVS or a Walgreen's without a prescription is considered an "OTC" item. 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. Spanish. HOME| CONTACT| ABOUT - Peter Palmiotto is an independent Medicare Broker and is not endorsed or employed by any insurance plan or any governmental agencies. H23U0t.C=0agn`ghPe @F !C=33=3c=K Look up plan benefits document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! endstream endobj 138 0 obj <>/Subtype/Form/Type/XObject>>stream 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) Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. endstream endobj 122 0 obj <>/Subtype/Form/Type/XObject>>stream 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. Call anytimelearn more >>. You may name a relative, friend, attorney, doctor or someone else to act for you. The items ship for free. CHIROPRACTIC - Just like acupuncture, the Chiropractic benefits work the same way. endstream endobj 132 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 129 0 obj <>/Subtype/Form/Type/XObject>>stream A quality of care complaint can also be filed with the Quality Improvement Organization (QIO) in Maryland. This is called a "Trial Right" and you can read about it on Medicare.gov's website. 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. /Tx BMC 10,000+ Maryland Providers Variety of Medicare Plans Advantage MD Care Team There are no costs for my services and you'll never pay extra for your insurance if you allow me to help you. Esta informacin est disponible gratis en otros idiomas. For more information, see the section titled Chapter 9. There are dozens of benefits built inside of a Medicare Advantage Plan that you simply do not receive when on original Medicare (A & B only). When we have completed the review, we give you our decision. Additionally, these services allow you to bring along one companion to ride with you. If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and mail it to us. 196 0 obj <>stream 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. 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. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. The Office of the Medicare Ombudsman can also help you with complaints and grievances. Browse provider manuals. You can call 24/7, if I don't personally answer, one of my assistants will take a quick message. Johns Hopkins Advantage MD, P.O. endstream endobj 135 0 obj <>/Subtype/Form/Type/XObject>>stream You can reach the Medicare Compliance Department using the contact information listed below. endstream endobj 134 0 obj <>/Subtype/Form/Type/XObject>>stream Please note: the information in this section does not apply to AdvantageMD Group. endstream endobj 123 0 obj <>/Subtype/Form/Type/XObject>>stream So wherever life takes you, we're here to help. H23U0t.C=0agn`ghPe @F !C=33=3c=K At Johns Hopkins HealthCare LLC (JHHC), we are committed to making it easy for providers to work with us. The following resources are available for physicians and patients when these actions are required. 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. Johns Hopkins Advantage MD, P.O. I am interested in ArchCare services and would like more information.
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