0 0 0 rg Wrong. Ending your membership in Johns Hopkins Advantage MD may be voluntary (your own choice) or involuntary (not your own choice): If you are voluntarily ending your membership, there are only certain times during the year, or certain situations, when you may do so. HMO members: 877-293-4998 (TTY: 711), Johns Hopkins Advantage MD, PO BOX 3538, Scranton, PA 18505. For more information, see the section titled Chapter 9. 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. When we have completed the review, we give you our decision. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. 0 0 0 rg This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care. For other types of problems, you need to use the process for making complaints, which are also called grievances. 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. They have both brand name items and store brands available. 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. Call Johns Hopkins Advantage MD at 888-403-7662. So wherever life takes you, we're here to help. EMC The QIO is a group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients. /Tx BMC We will give you our decision sooner if you have not received the drug yet and your health condition requires us to do so. 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. If you want a Provider or Pharmacy Directory mailed to you, or if you need help finding an in-network provider, please call Customer Service, 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 network: call 877-293-5325 (TTY: 711) HMO network: call . HEARING - Just like the Vision benefit description, these benefits are separate from a hearing specialist (which everyone can access as long as it's medically necessary). Some of the new Eastern Shore Medicare Advantage Plans will be offering an OTC benefit. There are no longer any medical questions to be approved. 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. ArchCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. I've seen savings as high as 70% using this type of benefit. Don't rule out these Advantage Plans simply because you heard something bad about them. Your health and satisfaction are important to us. Prior to 2022, Advantage Plans were extremely limited in this are of Maryland. We will give you our decision sooner if your health condition requires us to. If there is anything else you need to do, we will let you know. 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. They offer both HMO and DSNP Plans and have a "give back" option which puts money back into your Social Security Check each month (this specific give-back plan does not include Rx coverage) These additions would add to existing companies offering plans on the Eastern Shore which were previously Lasso Healthcare (all counties) and the Johns Hopkins Medicare Advantage Plan (in select counties). Chapter 9 of your plans EOC will provide more specific information about our process for appeals, grievances, and coverage decisions. I look forward to helping you! f Look up plan benefits 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. TRANSPORTATION - Some of the new plans offer free transportation (door-to-door) to plan approved locations. For specific instructions on how to file an appeal, you or your representative may: NEW: Johns Hopkins Advantage MD Appeals, P.O. The balance is your responsibility, but that's still an amazing deal! If we determine that your request does not meet the criteria above, then it will be handled as a standard coverage decision, The 14-day extension on fast coverage decision or fast appeal; or. When we are using the fast deadlines, we must give you our answer within 72 hours after we receive your appeal. endstream endobj 131 0 obj <>/Subtype/Form/Type/XObject>>stream Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. EMC If you do so, your membership will end when your new plans coverage begins on January 1. You also have a right to file a grievance (also called a complaint) about the health plan. Alterwood Advantage is a brand new company for 2022 and has some amazing plan offerings throughout Maryland. You can only end your membership with Johns Hopkins Advantage MD during certain times of the year. hbbd```b``. When you appeal a decision for the first time, this is called a Level 1 Appeal. Those include: If you choose to switch to Original Medicare during this period, you have until March 31 to join a separate Medicare prescription drug plan to add drug coverage. However, if you ask for more time, or if we need to gather more information that may benefit you, we can take up to 14 more calendar days. They include (but are not limited to): formulary exceptions, step therapy exceptions, and tier exceptions. /Tx BMC View recent announcements. You also have the right to ask for an expedited (fast) grievance. HMO members: 877-293-4998 (TTY:711). You have the right to request a fast grievance if you disagree with: Upon receipt of the grievance, we will promptly investigate the issue you have identified. Likewise, if you are a caregiver for an Advantage MD member, the member must provide authorization for Advantage MD to speak with you. Benefit levels vary by plan. To start your appeal, you, your doctor or your representative must contact our plan. /Tx BMC Starting in 2022, there will be four new companies to enter into the Eastern Shore counties. 1| 4 O("J0 /Tx BMC %PDF-1.6 % 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. Medicare Reconsideration Request (CMS-20033) What's it used for? EMC 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. Additionally, CareFirst is expanding into Calvert and Saint Mary's Counties. 0.5 0.5 0.5 rg /Tx BMC =`r&wH0dPU|0y,~L8w>da8fg"%`v' Use the resources on this site to help you get the most out of your Advantage MD plan. Box 3538 Scranton, PA 18505 Medicare Compliance Department Contact Information Johns Hopkins HealthCare has a Compliance Department Division dedicated to Johns Hopkins Advantage MD. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. endstream endobj 117 0 obj <>/Subtype/Form/Type/XObject>>stream Wpt.$1#NPq$##?LwA7sYt||V$it\=-f-7H 5YR`mym6h[av=tnz]OoE.Z-xkZ Privacy Practices Terms & Conditions Accessibility Interoperability Medicare.gov, Notice of Nondiscrimination: Limitations, copayments and restrictions may apply. By fax: Fax the completed Redetermination Request Form within sixty (60) days from the date of the notice of coverage determination to 18556337673. H23U0t.C=0agn`ghPe @F !C=33=3c=K You are unhappy with the cleanliness or condition of a hospital, doctors office or pharmacy. If your health requires it, ask for a fast appeal.If we are using the fast deadlines, we will give you our answer within 72 hours after we receive your Part C (Medical) or Part D (prescription drug) appeal. Information on Coronavirus (COVID-19) At Advantage MD, we want to make sure you have accurate information, know what to expect, and are empowered to care for your own and your family's health. If you are using a screen reader and need to increase the timeout length to avoid timing out, then click to follow this link to the change timeout page in order to change your timeout length to avoid timeouts. If you are asking for a standard appeal, make your appeal by submitting a written request. endstream endobj 130 0 obj <>/Subtype/Form/Type/XObject>>stream f hMdc'$Rs$5 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. Since 2011, I've been an independent Medicare insurance broker. Let's say you have a $150 annual benefit for "vision benefits." When you have a problem or concern, please call ArchCare Advantage Customer Service Department first at 18003733177 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m. Our customer service staff will work with you to try to find a satisfactory solution to your problem. Appeals Process Johns Hopkins HealthCare will reconsider denial decisions in accordance with the provider manual and contract. There's no cost to have the coverage (it's included in your monthly plan premium) but there are typically small co-payments or co-insurance amounts that you will be responsible for. There are four ways to file an appeal for Part D (prescription drugs) determination: You can download the Redetermination Request Form to use for your appeal: If we say no to your appeal, you can then choose whether to accept this decision or continue by making another appeal. hYo8WK N5q4Wl,7],&Efh4 S!*6"| -#0!'@-qD@)4,U`U"M}up"x#P$"d8@D If we do not give you an answer by the deadline above (or by the end of the extended time period if we took extra days), we are required to send your request on to Level 2 of the appeals process, where it will be reviewed by an independent outside organization. 8 a.m.-8 p.m., 7 days a week. The Level 3 Appeal is handled by an administrative law judge. That means you can get a filling, caps, crowns etc. The following resources are available for physicians and patients when these actions are required. ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Read more about coronavirus. EMC To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . http://www.ltcombudsman.ny.gov/. Under certain circumstances, which we discuss later, you can request an expedited or fast coverage decision or fast appeal of a coverage decision. DID YOU KNOW? If you have questions about the appeals process or would like to know the status of an appeal youve filed, please call us. You believe that someone did not respect your right to privacy or shared information you feel should be confidential. Benefits, formulary, pharmacy network, premium and/ or co-payments/co-insurance may change on January 1 of each year. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. Our denial of your request to expedite acoverage decisionor reconsideration for health services. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). You can go back to your Medicare Supplement plan at ANY TIME within the first 12 months of trying a Medicare Advantage Plan for the first time (this must be your first time on a Medicare Advantage plan), without any medical questions. Use of the Johns Hopkins Enterprise Directory (JHED) Computer System, shall be solely for the business purposes of the Johns Hopkins I Contact JHHC. Baltimore Johns Hopkins Pharmaquip Inc is a medicare enrolled Durable Medical Equipment & Medical Supplies Supplier in Baltimore, Maryland. To see a full list of examples of situations that meet the criteria for the Special Enrollment period, visit. Johns Hopkins Enterprise Directory v.5.38.1. The Annual Enrollment Period (AEP), which happens from October 15 to December 7. If your previous broker didn't tell you about this amazing rule, get a new broker! endstream endobj 132 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC This organization is not connected with us, and it is not a government agency. Advantage MD Participating Provider Post-Service Payment Dispute Form This form should be completed within 90 days of notification of denial (remittance). From April 1September 30, you will need to leave a message on weekends and holidays. This information is available for free in other languages. The Level 2 Appeal is conducted by an independent organization that is not connected to us. Appointment of Representative Form English You must continue to pay your Medicare Part B premium. endstream endobj 126 0 obj <>/Subtype/Form/Type/XObject>>stream If you have any questions, please contact Customer Service at 877-293-5325. H23U0t.C=0agn`ghPe @F !C=33=3c=K This is a Medicare rule, people just don't know about it. %%EOF There are three ways to file an appeal for Part C medical services: Payment appeals are accepted only in writing. 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. This organization is a company chosen by Medicare to review our decisions about your benefits with us. This type of complaint does not involve coverage or payment disputes. endstream endobj 120 0 obj <>/Subtype/Form/Type/XObject>>stream You can reach out to the office of Johns Hopkins Pharmaquip Inc via phone at (410) 288-8036. These instructions will tell who can make this Level 2 Appeal, what deadlines you must followand how to reach the review organization. Box 8777, Elkridge, MD 21075. 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. Yorb Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Johns Hopkins Advantage MD is available to residents of these counties: document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); I would like a representative to call me to speak about questions regarding enrolling in a plan. If the plan denies coverage for your requested item or service, you have the right to appeal and ask us to reconsider the decision. If you are not satisfied with the decision at the Level 2 Appeal, you may be able to continue through additional levels of appeal. Request a 3rd appeal By phone: 18003733177 (TTY/TDD 711), seven days a week, 8 a.m. to 8 p.m. By mail: Appeals & Grievances Department, 205 Lexington Avenue, 8th Floor New York, NY 10016. For any service or supply, the lesser of (1) the provider's actual charge to the patient or (2) the amount that would be allowed by Medicare, increased by a percentage determined by Johns Hopkins Employer Health Programs, not to exceed 150% of the amount that would be allowed by Medicare. EMC These items are things like food pantry items (rice, beans, bread etc), band aids, creams, lotions, vitamins etc. The exception forms can be submitted online, by fax, or by mail. Chapter 9 of the Evidence of Coverage Determinations has more information about Levels 3, 4and 5 of the appeals process. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! Annapolis Junction, MD 20701. /Tx BMC If the dollar value of the coverage you are requesting meets the requirement, you choose whether you want to take your appeal further. If we make a coverage decision that you are not satisfied with, you can appeal the decision. If we end your membership in our plan, we will tell you our reasons in writing for ending your membership and tell you how you can make a complaint about our decision to end your membership. There is no cost for this.
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