Medical Provider Informational Memorandum

Disputes involving a Medicare Health Maintenance Organization (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee-For-Service (PFFS), or Medicare Provider Sponsored Organization (PSO), and Medicare Part D (prescription coverage) should be filed directly with the:

Centers for Medicare and Medicaid Services

Division of Medicare
61 Forsyth Street #4T20
Atlanta, Georgia 30303-8909
Telephone Number: (404) 562-7500

Complaints involving a commercial HMO and a denial of service, pre-existing condition(s), non-emergency, etc., will not be addressed through this process. In those cases, the patient must file a grievance with his/her HMO. The instructions for filing a grievance will be found in their contract with the HMO. The HMO has 60 days to respond to the grievance. If after 60 days the problem has not been resolved, the patient can appeal to the Subscriber Assistance Program. For additional information, please call the Agency for Healthcare Administration toll-free at 1-888-419-3456.

Disputes involving Self-insured Non-Governmental Plans should be referred to the:

U.S. Department of Labor

* Employee Benefit Security Administration
8040 Peters Road, Bldg. H, Suite 104
Plantation, FL 33324
Toll Free Helpline: 1-866-275-7922 or Direct: 954-424-4022

* NOTE: As per the U.S. Department of Labor, complaints must be filed by the patient/insured or his/her legal representative).

Disputes involving Federal Employee Plans should be referred to the:

U.S. Office of Personnel Management

Federal Employee Health Benefit Programs
Insurance Review Division, #1
1900 E. Street NW
Washington, DC 20415-3500
Telephone Number: (202) 606-0727

Disputes involving Tricare (Military) Claims should be referred to the:

Palmetto Government Benefits Administration

Tricare Claims Department
PO Box 7031
Camden, SC 29020-7031
Toll Free Number: 1-800-403-3950 South Region or
Web site Address: www.tricare.osd.mil