What to know about the Medicare Beneficiary Ombudsman (MBO)

Medical News Today

2 days ago

Medicare is a complex system. The Medicare Beneficiary Ombudsman (MBO) is a client advocate who provides support and information to help enrollees understand their options and navigate Medicare.An ombudsman works within an organization on behalf of its clients to help resolve grievances and improve the organization's functioning. The MBO fills this role for the Medicare program.Under Medicare, individuals have clearly outlined rights and protections. These include the right to fair treatment and clear information. The MBO works to ensure that these rights are upheld.Learn more about the role of the MBO, a person's rights under Medicare, and where to direct complaints or inquiries related to Medicare.Function of the MBOThe MBO position was established by Congress in 2003 through the Social Security Act §1808.The MBO's overarching goal is to be an expert in the field of healthcare and Medicare education and help enrollees in various ways.Key duties of the MBO, as described in the Social Security Act, include:Assisting with issues: The MBO helps beneficiaries by processing complaints, grievances, and requests for information related to Medicare. It also provides assistance during coverage disputes.Sharing information: The MBO works with Medicare counseling programs to ensure that beneficiaries have access to information regarding their Medicare options and coverage.Reporting to Congress: The MBO reports to Congress on the functioning of the MBO position and makes recommendations on its improvement. It also identifies and flags potential issues with Medicare coverage or payment policies.Specific questions that may receive attention from the MBO include those related to appeals, enrollment concerns, and claims. Individual rights under MedicareAs Medicare beneficiaries, people have various rights and protections.Medicare rights include:fair and courteous treatmentnondiscriminationprivacy of personal and medical informationaccess to care for medically necessary servicesaccess to clear information about coverage and treatment optionsanswers to Medicare questionsMedicare protections ensure that people with Original Medicare receive written notice if any items or services will not be covered under Medicare. This is called an Advance Beneficiary Notice (ABN) of Noncoverage.When a person receives an ABN, they have a few options:They can choose to receive the noncovered services and have the provider submit a claim to Medicare. In this case, they pay the costs up front. They can file an appeal if Medicare denies the claim.They can choose to receive the noncovered services without their provider submitting a claim. In this case, they pay the full cost up front and cannot file an appeal.They can also choose not to receive the services. In this situation, they do not need to pay any costs.One of the functions of the MBO is to ensure that people receive fair treatment within the Medicare program.If a person believes they have been treated unfairly or that their rights or protections have been violated, they may wish to consult the MBO for guidance.How to contact the MBOThere are various ways to get in touch with the MBO. If a person has a question or concern related to Original Medicare, their first course of action should be to contact Medicare at 800-633-4227 (TTY: 877-486-2048).If a person has Medicare coverage through a private insurance company, such as a Medicare Advantage (Part C) plan or Part D prescription drug plan, they should reach out to a representative of their plan first.The MBO also works closely with State Health Insurance Assistance Programs (SHIPs). If a person has questions about claims, appeals, enrollment, or complaints, the local SHIP can assist them in finding a resolution. Finally, if a person has not found a resolution to their inquiry through the above methods, they can contact Medicare and request that their concerns be directed to the MBO.SummaryThe MBO is a Medicare representative who works on behalf of Medicare enrollees to ensure access to information and resolve complaints.The MBO also submits an annual report to Congress with recommendations on how to improve the role and functioning of the Medicare system.If a person has a question or grievance regarding Medicare, they can contact Medicare by phone or speak with a representative from their local State Health Insurance Assistance Program (SHIP). If these avenues cannot help resolve the query, a person can request that their case be sent to the MBO.