Welcome to MMM of Florida, Inc.

Thank you for being our member. Your satisfaction is important to us. We are open extended hours year-round to better assist you. Please allow us the opportunity to help and serve you. Please contact us with any questions or concerns.
If you have a complaint, you or your authorized representative may contact:
MMM of Florida – Member Services Department at 1-844-212-9858 (Toll free), 711 TTY (hearing impaired), from Monday to Friday, 8:00 a.m. to 8:00 p.m.

If you want to write to us rather than file a verbal grievance, you may address your correspondence to the following address:

MMM of Florida – Member Services Department at
1-844-212-9858 (Toll free)
711 TTY (hearing impaired)
from Monday to Friday, 8:00 a.m. to 8:00 p.m.

If you want to write to us rather than file a verbal grievance, you may address your correspondence to the following address:

MMM Medicare and Much More
Appeals and Grievances
P.O. Box 260430
Miami, FL 33126

Please carefully review the detailed Grievance and Appeal information below along with other important information.

Grievances

The Centers for Medicare and Medicaid Services (CMS) defines a grievance as any complaint or dispute, other than an organization determination, expressing dissatisfaction with the way a Medicare health plan or delegated entity provides health care services. An enrollee or their authorized representative may make the complaint or dispute, either orally or in writing, to MMM of Florida. Examples of grievances include but are not limited to:

• Quality of your care during a doctor’s appointment or hospital stay

• Waiting times on the phone or at your doctor’s office

• The way your doctor or others behave

• Not being able to reach someone by phone or obtain the information you need

• Lack of cleanliness or the condition of the doctor’s office

We will notify you or your authorized representative of the decision about your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after receiving your complaint. In some cases, we may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.

Expedited Grievances

An expedited grievance may also include a complaint that MMM of Florida refused to expedite an organization determination or reconsideration or invoked an extension to an organization determination or reconsideration time frame. You have the right to request a fast review or expedited grievance if you disagree with the plan’s decision to provide an extension on your request for an organization determination or reconsideration, or the plan’s decision to process your expedited request as a standard request. We will notify you of our decision about an expedited grievance within 24 hours. You may call us or submit your written grievance by mail no later than 60 days after the incident to:

MMM Medicare and Much More
Appeals and Grievances
P.O. Box 260430
Miami, FL 33126

Please make sure you include your name, member identification number, date of birth, your signature or that of your authorized representative, date, and summary of the incident and supporting information

Appeals

An appeal is a request to MMM of Florida to review an unfavorable organization determination (Part C) or coverage determination (Part D). You will file an appeal if you want us to reconsider and change a decision, we have made about what Part C and D benefits. You may also file an appeal if you want us to reconsider and change a decision, we have made
about whether items or services are covered or how much you have to pay for covered items or services.

Part C Appeal (Reconsideration)

You can file your appeal in writing, include a brief summary and description of the service you would like to appeal and any supporting documentation. Please mail your appeal request to:

MMM Medicare and Much More
Appeals and Grievances
P.O. Box 260430
Miami, FL 33126

Once we receive the request, we will notify you of our decision as quickly as your health requires, but no later than 72 hours for expedited requests or 30 calendar days for standard service requests (the plan can take up to an additional 14 calendar days if you request additional time, or if we need additional information that may benefit you), or 60 calendar days for payment requests.

If the decision is unfavorable to you, in whole or in part, the plan must submit the case file and its decision for review to the Part C Independent Review Entity (IRE).

There are five levels in the Medicare Part C appeals process:

First Level: Reconsideration by the Health Plan
Second Level: Reconsideration by an Independent Review Entity (IRE).
Third Level: Hearing by an Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals.
Fourth Level: Review by the Medicare Appeals Council (MAC).
Fifth Level: Judicial Review in Federal District Court.

To file a complaint with Medicare you may call 1-800-Medicare (1-800-633-4227), available 24 hours a day, the seven days of the week. TTY users (hearing impaired) should call 1-877-486-2048. You may also access the Medicare Complaint Form.

Plans are expected to disclose grievance and appeals, upon request, to individuals eligible to elect a Medicare Advantage organization or a Part D Sponsor. If you are interested in receiving this information, please contact Member Services.