Disclosure form and evidence of coverage - Kaiser Permanente ...
Disclosure form and evidence of coverage - Kaiser Permanente ...
Disclosure form and evidence of coverage - Kaiser Permanente ...
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Complaints for Part D prescription drugs<br />
Call<br />
TTY 711<br />
Fax<br />
Write<br />
1-800-443-0815 (Calls to this number are free.)<br />
Seven days a week, 8 a.m. to 8 p.m.<br />
If your complaint qualifies for a fast decision,<br />
call the Part D Unit at 1-866-206-2973, 8:30<br />
a.m. to 5 p.m., seven days a week. See the<br />
"Coverage Decisions, Appeals, <strong>and</strong> Complaints"<br />
section to find out if your issue qualifies for a<br />
fast decision.<br />
This number requires special telephone<br />
equipment <strong>and</strong> is only for people who have<br />
difficulties with hearing or speaking. Calls to<br />
this number are free.<br />
Seven days a week, 8 a.m. to 8 p.m.<br />
If your complaint qualifies for a fast review, fax<br />
your request to our Part D Unit at 1-866-206-<br />
2974.<br />
For a st<strong>and</strong>ard complaint, write to your local<br />
Member Services <strong>of</strong>fice (see the Provider<br />
Directory for locations).<br />
If your complaint qualifies for a fast decision,<br />
write to:<br />
<strong>Kaiser</strong> Foundation Health Plan, Inc.<br />
Part D Unit<br />
P.O. Box 23170<br />
Oakl<strong>and</strong>, CA 94623-0170<br />
Medicare Website. You can submit a complaint about<br />
our Plan directly to Medicare. To submit an online<br />
complaint to Medicare, go to<br />
www.medicare.gov/MedicareComplaintForm/home.a<br />
spx.<br />
Where to send a request asking us to pay for<br />
our share <strong>of</strong> the cost for Services or a Part D<br />
drug you have received<br />
For more in<strong>form</strong>ation about situations in which you may<br />
need to ask us for reimbursement or to pay a bill you<br />
have received from a provider, see the "Requests for<br />
Payment" section.<br />
Note: If you send us a payment request <strong>and</strong> we deny any<br />
part <strong>of</strong> your request, you can appeal our decision. See the<br />
"Coverage Decisions, Appeals, <strong>and</strong> Complaints" section<br />
for more in<strong>form</strong>ation.<br />
Payment Requests<br />
Call<br />
TTY 711<br />
Write<br />
Website kp.org<br />
Medicare<br />
1-800-443-0815 (Calls to this number are free.)<br />
Seven days a week, 8 a.m. to 8 p.m.<br />
Note: If you are requesting payment <strong>of</strong> a Part D<br />
drug that was prescribed by a Plan Provider <strong>and</strong><br />
obtained from a Plan Pharmacy, call our Part D<br />
unit at 1-866-206-2973, 8:30 a.m. to 5 p.m.,<br />
seven days a week.<br />
This number requires special telephone<br />
equipment <strong>and</strong> is only for people who have<br />
difficulties with hearing or speaking. (Calls to<br />
this number are free.)<br />
Seven days a week, 8 a.m. to 8 p.m.<br />
Northern California Members<br />
<strong>Kaiser</strong> Foundation Health Plan, Inc.<br />
Claims Department<br />
P.O. Box 24010<br />
Oakl<strong>and</strong>, CA 94623-1010<br />
Southern California Members<br />
<strong>Kaiser</strong> Foundation Health Plan, Inc.<br />
Claims Department<br />
P.O. Box 7004<br />
Downey, CA 90242-7004<br />
If you are requesting payment <strong>of</strong> a Part D drug<br />
that was prescribed <strong>and</strong> provided by a Plan<br />
Provider, you can fax your request to 1-866-<br />
206-2974 or write us at P.O. Box 23170,<br />
Oakl<strong>and</strong>, CA 94623-0170 (Attention: Part D<br />
Unit).<br />
How to get help <strong>and</strong> in<strong>form</strong>ation directly from<br />
the federal Medicare program<br />
Medicare is the federal health insurance program for<br />
people 65 years <strong>of</strong> age or older, some people under age<br />
65 with disabilities, <strong>and</strong> people with end-stage renal<br />
disease (permanent kidney failure requiring dialysis or a<br />
kidney transplant). The federal agency in charge <strong>of</strong><br />
Medicare is the Centers for Medicare & Medicaid<br />
Services (sometimes called "CMS"). This agency<br />
contracts with Medicare Advantage organizations,<br />
including our Plan.<br />
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