All plans are required (by CMS) to reach out to you once a formal complaint has been filed to give you an explanation as to why they are not adhering to their formulary as stated to CMS. 

If a plan has many CMS complaints filed against them, then CMS will investigate the plan and potentially sanction that insurance company.

Here is how you file a complaint to CMS:

Step 1: Click on Find Patient at the top of your screen. Enter your patient’s name into the search bar. Click into the Medicare tab of the patient profile.

Scroll down until you find the specific plan you'd like to report. 

Step 2: Hover your mouse over the 3 grey dots at the bottom right of the plan box.

A drop down will appear with the option to "Report to CMS." Select this option, and the following window will appear: 

Step 3. Ensure that the patient information is correct. Write out your complaint in the subsequent text box. Be as detailed as possible. Then click the blue SEND COMPLAINT button.

Be sure to make a note of when you filed this complaint in your records, just in case you need to follow up later!

What's Next?

If you're looking to file a MAC Appeal or contact your insurance commissioner, check out this reference!

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