70 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Chapter 7: What to do if you have a problem or complaint (coverage decisions, appeals, complaints) Section 2 — Where to get more information and personalized assistance We are always available to help you. Even if you have a complaint about our treatment of you, we are obligated to honor your right to complain. Therefore, you should always reach out to Member Services for help. But in some situations, you may also want help or guidance from someone who is not connected with us. Below are two entities that can assist you. State Health Insurance Assistance Program (SHIP) Each state has a government program with trained counselors. The program is not connected with us or with any insurance company or health plan. The counselors at this program can help you understand which process you should use to handle a problem you are having. They can also answer your questions, give you more information, and offer guidance on what to do. The services of SHIP counselors are free. You will find phone numbers and website URLs in Chapter 2, Section 3, of this document. Medicare You can also contact Medicare to get help. To contact Medicare: • You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. • You can also visit the Medicare website (www.medicare.gov). Section 3 — To deal with your problem, which process should you use? If you have a problem or concern, you only need to read the parts of this chapter that apply to your situation. The guide that follows will help. Is your problem or concern about your benefits or coverage? This includes problems about whether medical care (medical items, services and/or Part B prescription drugs) are covered or not, the way they are covered, and problems related to payment for medical care. • Yes. ♦ Go on to the next section in this chapter, Section 4: "A guide to the basics of coverage decisions and appeals." • No. ♦ Skip ahead to Section 9 at the end of this chapter: "How to make a complaint about quality of care, waiting times, customer service, or other concerns." kp.org