Regarding DeanCare Gold (Cost) Plans
About DeanCare Gold
Limitations, copayments and restrictions may apply. Benefits, network premium and/or copayments/co-insurance may change on January 1, 2015. You must continue to pay your Part B premium. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Dean Health Plan. Dean Health Plan contracts with the federal government.
By law, DeanCare Gold can choose not to renew its Medicare contract. Medicare may also refuse to renew the DeanCare Gold contract, resulting in a termination or non-renewal. This may result in termination of the beneficiary's enrollment in DeanCare Gold. In addition, DeanCare Gold may reduce its service area and no longer offer services in the area where the beneficiary resides.
The Medicare program rates how well plans perform in different categories, such as customer service, detecting and preventing illness and ratings from patients, among others. You can use the web tools at The Official U.S. Government Site for Medicare to compare the plan ratings for Medicare plans in your area or click here to see how Dean Health Plan rates. To obtain a copy of the plan ratings you may also call Medicare directly at (800) MEDICARE (633-4227), or TTY call (877) 486-2048 (24 hours a day/7 days a week).
Complaints, Grievances and Appeals
Federal law guarantees your right to make complaints if you have concerns or problems with any part of your medical care as a plan member. The Medicare program has helped set the rules about what you need to do to make a complaint and what we are required to do when someone makes a complaint. A grievance is any complaint other than one that involves a coverage determination. You would file a grievance if you have any type of problem with us or one of our network providers not relating to coverage from the plan. An appeal is any of the procedures that deal with the review of an unfavorable coverage determination. You cannot request an appeal if we have not issued a coverage determination. If we issue an unfavorable coverage determination, you may file an appeal called a "redetermination" if you want us to reconsider and change our decision. If our redetermination decision is unfavorable, you have additional appeal rights. More information regarding this process can be found in Chapter 7 of your plan's Evidence of Coverage (Enhanced / Shared Value / Basic).
If you would like to request an organization determination or make an appeal, you may make your request in writing or verbally. The mailing address to send your written requests is:
Dean Health Plan
1277 Deming Way
Madison, WI 53717
You may also submit your organization determination or appeal request by telephone by calling the Customer Care Center at (888) 422-3326 (TTY: 711). (Calls to these numbers are free.)
You may also fax your request to: (608) 830-5920.
If you have questions on this process or wish to check the status of your request for an organization determination or appeal you can call our Customer Care Center at the numbers above.
If you wish, you can name another person your “representative”, which allows them to request an organization determination or make an appeal on your behalf. If you want a friend, relative, provider, or other person to be your representative, call the Customer Care Center at the number above and ask for the Appointment of Representative form. When you complete that form, that person will have permission to act on your behalf. The form must be signed by you and by the person who you would like to act on your behalf. You must give our plan a copy of the signed form. There may be someone who is already legally authorized to act as your representative under State law. If that is the case, a copy of such legal authorization needs to be provided to our plan. You can also download a copy of the Appointment of Representative form required to grant this permission to an individual of your choosing.