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RIGHTS & RESPONSIBILITIES

Know your rights

As a member, you have certain rights and responsibilities. We’ve explained them here so that you can become more involved in the care you receive.
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You have the right to ask for coverage

Don’t be afraid to ask us to cover something that you and your doctor feel you need. We take every request seriously and want you to get the care that’s right for you.

How do I ask for medical services to be covered?

You, your doctor or your representative can contact us about providing coverage for medical care. If we won’t cover your request, then we’ll tell you in writing why not and explain how you can appeal our decision.

Call:
1-800-474-64771-800-474-6477 (TTY: 711711)

From October 1 to March 31, you can call us from 8 a.m. to 8 p.m. CT, 7 days a week. From April 1 to September 30, you can call us from 8 a.m. to 8 p.m. CT, Monday through Friday. If you call outside of these hours or on a holiday, just leave a message on our automated phone system, and we’ll get back to you the next business day.

Fax:
1-844-569-5550

Mail:
Shared Health Mississippi
309 Newpointe Drive
Ridgeland, MS 39157

How do I ask for prescriptions to be covered?

You, your physician or your representative should fill out a Request for Medicare Prescription Drug Coverage Determination form and send it to us by mail or fax.

Call:
1-800-474-64771-800-474-6477 (TTY: 711711)

From October 1 to March 31, you can call us from 8 a.m. to 8 p.m. CT, 7 days a week. From April 1 to September 30, you can call us from 8 a.m. to 8 p.m. CT, Monday through Friday. If you call outside of these hours or on a holiday, just leave a message on our automated phone system, and we’ll get back to you the next business day.

Fax:
1-844-569-5550

Mail:
Shared Health Mississippi
309 Newpointe Drive
Ridgeland, MS 39157

You’ll normally get a decision in 14 days. If you think your health could be seriously harmed by waiting that long, you can request a decision within 72 hours. These fast requests can be requested by you, your representative or any doctor — even if they’re not affiliated with Shared Health Mississippi.

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You have the right to ask us to reconsider a decision

If we’ve made a decision you don’t agree with, you can ask us to reconsider (or “file an appeal”) within 60 calendar days of the date of the initial decision.

How do I file an appeal for medical services?

You or your representative will need to send a letter or complete the Appeals Form and contact us.

Mail:
Shared Health Mississippi
309 Newpointe Drive
Ridgeland, MS 39157

If you have any questions about the appeal process, our team is ready to listen and help.

Call:
1-800-474-64771-800-474-6477 (TTY: 711711)

From October 1 to March 31, you can call us from 8 a.m. to 8 p.m. CT, 7 days a week. From April 1 to September 30, you can call us from 8 a.m. to 8 p.m. CT, Monday through Friday. If you call outside of these hours or on a holiday, just leave a message on our automated phone system, and we’ll get back to you the next business day

How do I file an appeal for prescriptions?

You, your physician or your representative should fill out a Request for Medicare Prescription Drug Coverage Redetermination form and send it to us by mail or fax.

Call:
1-800-474-64771-800-474-6477 (TTY: 711711)

From October 1 to March 31, you can call us from 8 a.m. to 8 p.m. CT, 7 days a week. From April 1 to September 30, you can call us from 8 a.m. to 8 p.m. CT, Monday through Friday. If you call outside of these hours or on a holiday, just leave a message on our automated phone system, and we’ll get back to you the next business day.

Fax:
1-844-569-5550

Mail:
Shared Health Mississippi
309 Newpointe Drive
Ridgeland, MS 39157

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You have the right to make a complaint

If you aren't satisfied with the quality of care you received through your plan, a network provider or a network pharmacy, you can file an official complaint (or grievance).

How do I submit a complaint?

A grievance is a type of complaint you make about your plan, a network provider or a network pharmacy. This includes complaints concerning the quality of your care. You have to submit your complaint no later than 60 days after the event.

To get started, complete a Grievance Form and fax it to us.

Fax:
1-844-569-5550

If you have a complaint about a coverage decision or a claim denial, you have the right to ask us to reconsider this decision. The Medicare Beneficiary Ombudsman is a person who reviews complaints (also called “grievances”) and helps resolve them. To contact the Medicare Beneficiary Ombudsman, call 1-800-MEDICARE1-800-MEDICARE or 1-800-633-42271-800-633-4227 (TTY: 1-800-486-20481-800-486-2048). Or you can fill out Medicare's complaint form to send feedback about issues with your Medicare plan. For more information, visit medicare.gov.

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You have the right to have someone represent you

If you need help filing an appeal, you can assign a family member, friend, advocate, attorney or doctor to represent you.

What can my representative do?

Your representative can:

  • Get information about your claim
  • Submit evidence
  • Make requests
  • Give or receive notices about the appeal
How do I appoint a representative?

Both you and your representative need to sign, date and fill out the Appointment of Representative form. Then send us the completed form with your coverage decision request.

Mail:
Shared Health Mississippi
309 Newpointe Drive
Ridgeland, MS 39157

Fax:
1-844-569-5550

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You have the right to leave your plan

We want to help you understand your responsibilities and ours when it comes to leaving your plan (or disenrollment).

When can I end my membership?

You have a special election period once per quarter for the first nine months of the year (January–September). Some people may have more limits on when they can enroll. For more details, see Chapter TBD of your Evidence of Coverage.

If you have any questions, please give us a call.

Call:
1-800-474-64771-800-474-6477 (TTY: 711711)

From October 1 to March 31, you can call us from 8 a.m. to 8 p.m. CT, 7 days a week. From April 1 to September 30, you can call us from 8 a.m. to 8 p.m. CT, Monday through Friday. If you call outside of these hours or on a holiday, just leave a message on our automated phone system, and we’ll get back to you the next business day.

Can I be disenrolled from my plan?

Your health is important to us, but we would have to end your membership in the plan if any of the following happens:

  • You don't stay continuously enrolled in Medicare Part A and Part B.
  • You lose your Medicaid coverage.
  • You move out of the service area for more than six months.
  • You no longer meet the specific special needs status.
  • You become incarcerated.
  • You lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • You intentionally give us incorrect information while enrolling in our plan, and that information affects your eligibility.
  • You continuously behave in a way that is disruptive and makes it difficult for us to provide medical coverage for you and other members of our plan.
  • GetYou let someone else use your membership card to get medical care.
  • GetYou enroll in the Program of All-inclusive Care for the Elderly (PACE).
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