Member rights and responsibilities

Medicare member rights¹

If you have Medicare, you have the right to be:

Treated with courtesy, dignity and respect at all times
Protected from discrimination. Every company or agency that works with Medicare must obey the law. They can't treat you differently because of your race, color, national origin, disability, age, religion, or sex

You have the right to have:

Your personal and health information kept private
Access to doctors, specialists, and hospitals for medically necessary services

You have the right to get:

Medicare-covered services in an emergency
Information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors
Information about your treatment choices in clear language that you can understand and participate in treatment decisions
Medicare information and health care services in a language you understand
Your Medicare information in an accessible format, like braille or large print
Answers to your Medicare questions
A decision about health care payment, coverage of items and services, or drug coverage

When you or your provider files a claim, you’ll get a notice letting you know what will and won’t be covered. This notice may come from:

Medicare
Your Medicare Advantage Plan (Part C) or other Medicare health plan
Your Medicare drug plan for Medicare drug coverage (Part D)

If you disagree with the decision on your claim, you have the right to file an appeal. You may:

Request a review (appeal) of certain decisions about health care payment, coverage of items and services, or drug coverage
File complaints (sometimes called “grievances"), including complaints about the quality of your care. You may decide to do this if you have concerns about the quality of care and other services you get from a Medicare provider

¹Medicare.gov, Your Rights

Medicare customers have the responsibility:

To know and confirm your benefits before getting treatment
To show your member ID card before getting services
To protect your member ID card from being used by another person
To verify that the provider you get services from is part of the health plan network
To keep scheduled appointments
To pay any copayments/coinsurance at the time you get treatment
To ask questions and understand the care you are getting
To follow the advice of your provider and be aware of the possible outcomes if you do not
To tell us your opinions, concerns and complaints
To give information when asked to the health plan and contracted providers that would help improve your health status
To use emergency room services only for an injury or illness that you might think may be a serious threat to your life or health
To follow the treatment plan agreed upon by you and your provider
To give all the health plan staff respect and courtesy
To tell us of any change in address

If you have questions or concerns about your rights, please call UnitedHealthcare Customer Service at the phone number listed on your member ID card. If you need help with communication, such as help from a language interpreter, customer service can assist you.

The Medicare program has written a booklet called Your Medicare Rights and Protection. To get a free copy, call 1-800-MEDICARE (1-800-633-4227) / TTY (1-877-486-2048) 24 hours a day, 7 days a week. Or you can access the Medicare website , to order the booklet or print it from your computer.

Appeals and grievances

As a plan member, you may request statistical information on appeals and grievances by contacting the UnitedHealthcare Appeals and Grievances Department:

Phone (toll-free):

FED TFN / TTY 711
Hours of operation: every day, 8 a.m. to 8 p.m.

Mail:

UnitedHealthcare
Attn: Appeals and Grievances
P.O. Box 6106
Cypress, CA 90630
Mail Stop: CY124-0157

Supporting you through your Medicare journey

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