PPO II - EmblemHealth

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2013 Evidence of Coverage for PPO II) II Chapter 2: Important phone numbers and resources SECTION 4 QUALITY IMPROVEMENT ORGANIZATION (PAID BY MEDICARE TO CHECK ON THE QUALITY OF CARE FOR PEOPLE WITH MEDICARE) Th ere is a Quality Improvement Organization for each state. For New York State, the Quality Improvement Organization is called the Island Peer Review Organization (IPRO). IPRO has a group of doctors and other health care professionals who are paid by the Federal government. Th is organization is paid by Medicare to check on and help improve the quality of care for people with Medicare. IPRO is an independent organization. It is not connected with our plan. You should contact IPRO in any of these situations: • You have a complaint about the quality of care you have received. • You think coverage for your hospital stay is ending too soon. • You think coverage for your home health care, skilled nursing facility care, or Comprehensive Outpatient Rehabilitation Facility (CORF) services are ending too soon. Island Peer Review Organization (IPRO) (New York State’s Quality Improvement Organization) CALL 1-800-331-7767 (Quality of care complaints or concerns) 1-888-880-9976 (Hospital issued notices of Medicare non-coverage) 1-888-696-9561 (Non-hospital issued notices of Medicare non-coverage) TTY 711 (New York State Relay Service) WRITE IPRO 1979 Marcus Avenue Lake Success, NY 11042-1002 WEBSITE www.ipro.org 25
26 SECTION 5 SOCIAL SECURITY 2013 Evidence of Coverage for PPO II Chapter 2: Important phone numbers and resources Social Security is responsible for determining eligibility and handling enrollment for Medicare. U.S. citizens who are 65 or older, or who have a disability or End-Stage Renal Disease and meet certain conditions, are eligible for Medicare. If you are already getting Social Security checks, enrollment into Medicare is automatic. If you are not getting Social Security checks, you have to enroll in Medicare. Social Security handles the enrollment process for Medicare. To apply for Medicare, you can call Social Security or visit your local Social Security offi ce. Social Security is also responsible for determining who has to pay an extra amount for their Part D drug coverage because they have a higher income. If you got a letter from Social Security telling you that you have to pay the extra amount and have questions about the amount or if your income went down because of a life-changing event, you can call Social Security to ask for a reconsideration. Social Security CALL 1-800-772-1213 Calls to this number are free. TTY 1-800-325-0778 Available 7:00 am to 7:00 pm, Monday through Friday. You can use Social Security’s automated telephone services to get recorded information and conduct some business 24 hours a day. This number requires special telephone equipment and is only for people who have diffi culties with hearing or speaking. Calls to this number are free. WEBSITE http://www.ssa.gov Available 7:00 am to 7:00 pm , Monday through Friday.
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