Friday, October 5, 2012

Who to Contact When You Need to File a Healthcare Related Grievance

As I discussed on Wednesday in my post Lessons Learned as a Patient in the UCLA Health System, sometimes you just need to file a complaint or grievance when things don't go the way they ought to when it comes to your healthcare.

Since I'm going through this process now myself, I decided to put together a resource list to share with you here on my blog.  I hope my research on this topic will make starting the process a little easier for you. Plus I was pleasantly surprised when I discovered that many of these agencies are set up to take complaints online, which saves you the hassle of printing and preparing forms and heading to the post office to get them in the mail.

So here they are, my suggested list of organizations to contact in the United States when you have grievance against your physician, nurse, hospital and/or health plan:

Hospital and Health Facility Complaints:

Most hospitals and healthcare facilities have in-house patient services departments that may be able to help you.  Start by asking a member of your healthcare team about who is available to assist you, like your nurse, social worker or the receptionist.  You can also call the hospital operator and ask for the name and number of the department that handles patient complaints.

Call your health insurance company.
  1. They may have a nurse case management program that can advocate on your behalf.  Their nurses will talk with you, contact your medical providers and working with you to manage your health care.  This may be a free benefit to you depending on your health plan.
  2. You can ask to file a complaint against any network or preferred hospital or facility and your insurance company's provider relations department will investigate.  Just know that they may not inform you of the results of their investigation.
The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a non-profit organization that accredits hospitals and health institutions nationwide.  Their Office of Quality Monitoring will review complaints filed against accredited institutions.

Contact your state's Department of Health.  This is the agency in your state that is either responsible for, or can connect you to, the division that licenses health care facilities.  You can browse a complete list of each states' Department of Health here courtesy of the Centers for Disease Control website.

In addition, your state may have a Health Care Association or Society that might want to hear about your concerns.  While not present in every state, you can see a list for some of the organizations here courtesy of the Joint Commission website.

Physician Complaints:

Call your health insurance company.
  1. They may have a nurse case management program that can advocate on your behalf.  Their nurses will talk with you, contact your doctor and work with you both to manage your health care.  This may be a free benefit to you depending on your health plan.
  2. You can ask to file a complaint against any network or preferred physician (or other health care providers.)  Their provider relations department will investigate your complaint.  Just know that they may not inform you of the results of their investigation.
Contact your state's Medical Society or Association.  These are membership societies so you'll first want to verify that your doctor is a member.  Then check to see if they are set up to receive complaints directly or if they provide referrals to the organizations in your state who are.  Find a complete list of medical societies here courtesy of the American Medical Association.

Your doctor needs to be licensed to practice medicine and your state's Medical Licensing Board is the entity that handles consumer complaints about doctors.  Look for the complete list here courtesy of the American Medical Association.
NOTE: Your state may also have licensing boards for other allied health professionals, like chiropractors  pharmacists, psychologists, social workers and physical and occupational therapists.
Nurse Complaints:

Nurses also need to be licensed to practice nursing, so if your complaint is about a nurse practitioner, registered nurse, licensed practical nurse or certified nursing assistant, contact the State Nursing Board.  You can view a complete list here courtesy of the National Council of State Boards of Nursing.

Health Plan Complaints:

Health plans are required by law to have a process to receive and respond to member complaints and grievances. So don't hesitate to call your health insurance plan, tell them you are dissatisfied with their services, determination of benefits or the health care treatment received through their plan and want to file a complaint or grievance.  You can also refer to your member handbook or your health plan's website to learn how to use their grievance process.

If you are covered under an employer-sponsored health plan, consider talking to your Human Resources Department or contacting the U.S. Department of Labor’s Employee Benefits Advisors.

To contact your state's Department of Insurance, which regulates health insurance, head to the USA.gov website, click on your state and browse for the category State Insurance Regulators.

For complaints about your Medicare supplemental health plan or prescription drug plan, go here to the Medicare website to learn more about filing a complaint.

For complaints about Medicare, you can either speak with your State Health Insurance Program (SHIP) or the Medicare Beneficiary Ombudsman.

For information about filing a complaint about your state Medicaid program, contact your local County Office of Public Assistance.

Complaints About Medications:

Here is a complete list by state of Consumer Complaint Coordinators at the Food and Drug Administration (FDA) that you can call directly to report drug adverse reactions and other issues with FDA-regulated products.



This is not a complete list and I welcome your input in revising and expanding this resource.  In addition, I'd like to hear about your experiences in contacting any of the entities mentioned above, both good and bad.  So please feel free to add information and your input by submitting a comment below.


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