How to Complain to Medicare

How Medicare handles complaints and appeals is no trivial matter — the Centers for Medicare and Medicaid Services says it reviews more than 100,000 of them a year. Beneficiaries file roughly 16,000 annually related to hospital care (mostly contesting discharges) and 18,000 about nursing homes, home health services and hospice programs. And 30,000 other complaints and appeals concern Medicare Advantage programs.

On Aug. 1, Medicare made what should be a simple change in this process: There are new toll-free phone numbers to call. You may have already received the new numbers on the forms a hospital or nursing home provided about your rights. But if a health care provider hasn’t yet caught up with the change, you may not have.

And if you’re looking on the Medicare.gov website for phone numbers, I wish you luck. I went rummaging through the site several times without finding them, and so did the folks at the United Hospital Fund, until they finally located the proper tool.

The new phone numbers, which I’ll pass along in a minute, reflect a larger change. Each state has a quality improvement organization, a Q.I.O., which until now worked with providers on issues like reducing hospital readmissions or preventing infections, and reviewed beneficiaries’ complaints and expedited appeals.

Some beneficiaries and other critics, including the Institute of Medicine, saw potential conflicts of interests: Could the organization that advised providers also fairly review complaints against them? They recommended separating those functions.

“There was a question of, ‘If you also work with the hospital, are you really working in my interest?’ ” said Jean Moody-Williams, director of the Medicare agency’s quality improvement group. “We didn’t think that was actually happening,” but to avoid any perception of bias, the agency set up a new system.

Now, beneficiary appeals and complaints go to two large regional contractors, officially known — with the usual governmental flair — as Beneficiary and Family-Centered Care Quality Improvement Organizations, a.k.a, B.F.C.C. Q.I.O.s. Livanta, based in Maryland, handles nine Northeastern states and eight Western ones, and Puerto Rico and the Virgin Islands. An Ohio company called KePro oversees complaints in all the other states and Washington, D.C.

None of this should matter much if you want to contact Medicare because you believe that a hospital is discharging you before you’re strong enough to return home, or if you find that a home health aide has behaved badly. “We want it to be seamless for the beneficiary,” Ms. Moody-Williams said. “They just have a different number to call.”

O.K., but what’s the number? The old individual state Q.I.O. numbers are supposed to take you directly to Livanta or KePro, and when I called the old number for my state, I was indeed immediately redirected. But that presupposes you have the old numbers.

What you have to do to find the new ones through Medicare.gov, apparently, is go to this Medicare Helpful Contacts page, look down the “select an organization” menu for “Quality Improvement Organization (Beneficiary and Family Centered Care),” then enter your state. The proper Livanta or KePro number then materializes. Intuitive, right?

It’s simpler to find the new numbers by consulting the state by state guide that the United Hospital Fund has posted. “We were concerned that people didn’t know this change had taken place,” said Carol Levine, director of its families and health care project.

Eventually, this phone issue surely will get sorted out, but there are time limits for filing expedited appeals. “Concern is very justified,” said Terry Berthelot, a senior lawyer at the Center for Medicare Advocacy, which among other services represents Medicare beneficiaries in appeals. “In real time, there are probably people being affected.”