Tessa Quinn
If you've received poor medical care at a hospital, there are several ways to address the issue. Firstly, you can bring up your concerns directly with the hospital staff involved in your care, such as doctors and nurses, and ask how your issue can be resolved. Alternatively, you can speak to a hospital social worker who may be able to help solve your problem. If you have concerns about the quality of care, you can file a complaint or grievance with your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Additionally, you can file a complaint with independent accrediting organizations, such as The Joint Commission, or contact your state's medical society or licensing board for instructions on how to file a complaint. It's important to be aware of time limits and deadlines for filing complaints, so consider seeking legal advice if you intend to take this step.
| Characteristics | Values |
|---|---|
| Who to complain to | Doctor, nurses, hospital social worker, hospital discharge planner, hospital billing department, Medicare, Joint Commission, State Health Insurance Assistance Program (SHIP), U.S. Department of Health & Human Services Office for Civil Rights (OCR), Oregon Medical Board, Oregon Board of Psychology, Oregon Health Authority, American Medical Association |
| Reasons for complaint | Quality of care, refusal to cover a service, supply or prescription, incorrect medication, wrong surgery or treatment, premature discharge, hospital-acquired infection, issues with billing, discrimination |
| Mode of complaint | Online submission form, phone, email, mail |
| Time limits | Yes, there are time limits or deadlines for filing complaints, filing lawsuits, or taking legal action |
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What You'll Learn
How to complain about a bill or claim
If you have received a bill for a claim you already submitted, you can file a complaint or dispute the bill. Here is a step-by-step guide on how to complain about a bill or claim:
Step 1: Understand your bill
First, ask your doctor or the hospital's billing department to explain the charges. Compare your bill to the explanation of benefits provided by your insurance company, which should include information about your deductible, co-pay, and co-insurance. Ensure that the two match, as sometimes medical bills may forget to apply the "plan discount", resulting in a higher charge.
Step 2: Identify any errors
Review the billing codes on your detailed bill. CPT (Current Procedural Terminology) Billing Codes are used to describe medical, surgical, and diagnostic services, and there are multiple websites that allow you to search and understand these codes. Ensure that the codes on your bill match the procedures you received.
Step 3: Gather supporting documentation
If there is a billing error or discrepancy, clearly state the error, the CPT codes that were inaccurate, what the codes should have been, and the potential estimated difference in price. Attach any supporting documentation to your complaint.
Step 4: Submit your complaint or dispute
You can submit your complaint or dispute through an official complaint form, either online or by mail. If you are in California, you can file a complaint through the Patient Complaint Portal or mail the signed and completed Patient Complaint Form with copies of any supporting documents. If your insurance company or provider is not following surprise billing rules, you can submit a complaint to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372. Note that there is a $25 non-refundable administrative fee to file a dispute.
Step 5: Seek further assistance
If you are not getting a resolution or things are taking longer than promised, consider getting a patient advocate involved. Patient advocates are typically found in hospitals and large medical provider networks, and they can help reduce your bill and expedite the resolution of errors. You can also call your local State Health Insurance Assistance Program (SHIP) to get free, personalized health insurance counselling.
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What to do if you're discharged too early
If you feel that you are being discharged from the hospital too early, there are several steps you can take to address the situation. Firstly, it is important to understand your rights and options. You have the right to speak up and express your concerns if you don't feel safe or ready to leave the hospital.
- Talk to your doctor or physician: Discuss your concerns with your doctor and ask for an explanation of your diagnosis, new treatments, medication changes, and any symptoms to monitor.
- Contact a patient advocate: Reach out to a patient advocate, who can help monitor your care and advocate on your behalf. They can also assist in arranging a care meeting with your medical team to address your concerns and questions before discharge.
- Involve a family member or caregiver: Enlist the help of a trusted family member or caregiver to support you during your hospital stay and discharge process. They can provide valuable assistance and advocate for your best interests.
- Understand your insurance coverage: Contact your insurance company to discuss any concerns about your discharge. They can provide information about coverage for inpatient stays and the potential for delaying your discharge if necessary.
- Speak to a hospital social worker: Social workers can help resolve problems, identify resources, and organize services for your transition home. They can also facilitate discussions with your doctor if needed.
- File a complaint or grievance: If you believe you are being discharged too early, you can file a complaint with your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). This is especially relevant if you have concerns about the quality of care or feel your condition has not been adequately addressed.
Remember, it is important to be proactive and start thinking about discharge at the beginning of your hospital stay. This includes understanding your treatment plan, medications, and any caregiving needs you may have after leaving the hospital. Don't hesitate to speak up and advocate for yourself or seek help from others if you feel you are being discharged too early.
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Who to contact about mistreatment
If you feel you've been mistreated by a hospital, healthcare facility, doctor, or another mental health professional, there are several avenues you can take to address your concerns and file a complaint. Here are some options for who to contact:
Hospital Staff
Start by bringing your concerns to the relevant doctors and nurses as soon as possible. Be specific about your complaints and ask how they can be resolved. You can also request to speak with a hospital social worker, who can help mediate and identify resources. Social workers often handle services and paperwork when patients leave the hospital, so they may be particularly helpful if your complaint involves an early or inappropriate discharge.
Licensing and Accreditation Bodies
Most hospitals and medical facilities are licensed and accredited by independent companies or state authorities. These bodies often provide a mechanism for filing complaints. For instance, if you received Medicare and have concerns about the quality of care or early discharge, you can contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). You can also file a complaint with the Joint Commission if you acquired an infection during your hospital stay or had issues obtaining the correct medication.
State Medical Boards
You can contact your state's medical society or licensing board for instructions on filing a complaint. For instance, if you are in Oregon and feel mistreated by a medical doctor, you can file a complaint with the Oregon Medical Board. If your complaint involves a mental health professional, such as a psychologist, you can contact the Oregon Board of Psychology.
U.S. Department of Health & Human Services
If you feel you were mistreated due to discrimination based on your disability, you can file a complaint with the U.S. Department of Health & Human Services Office for Civil Rights (OCR). They can be reached by phone or email, and you can also file your complaint directly on their website.
Legal Options
If you wish to pursue legal action or sue a hospital or doctor for monetary damages, you will need to seek legal counsel and engage the services of an attorney. They can advise you on the specific timeframes and requirements for filing claims and guide you through the process.
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How to file a complaint about discrimination
If you've experienced discrimination in a healthcare setting, you have options to file a complaint about the unfair treatment you've received. Hospitals are required to establish a patient grievance process, and you can file a complaint without fear of retribution or discrimination. Here are the steps you can take:
Identify the Appropriate Channel
First, determine the specific nature of your complaint. If you believe you've been discriminated against because of your disability by a state or local government healthcare agency, you may file a complaint with the OCR (Office for Civil Rights). You can file this complaint for yourself or on behalf of someone else. However, please note that the OCR does not typically investigate complaints regarding housing, law enforcement, labour, education, or employment discrimination.
If your complaint is about the quality of care you received, you can contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). This is relevant if you have concerns about issues such as receiving the wrong medication, undergoing the wrong treatment or surgery, or being discharged too early.
The Joint Commission is another option for filing complaints. Approximately 80% of the nation's hospitals are accredited by this private, non-profit group, which requires hospitals to prohibit discrimination based on sexual orientation, gender identity, or expression. They will review all quality-of-care complaints and can be contacted by phone or email.
Additionally, many state health departments have a hospital licensing division that may provide a way to file a complaint if state laws or regulations have been violated.
Gather Information and Documentation
Before filing your complaint, ensure you have all the relevant information and documentation. This includes the date of the incident, a detailed description of what occurred, and any other supporting evidence. If your complaint is about billing issues, gather the date of service, the total charge in question, and the name of your doctor and hospital.
Submit Your Complaint
Most organizations accept complaints submitted online, by mail, or via phone. The OCR, for instance, requires electronic submission through their OCR Complaint Portal. The Joint Commission also prefers online submission for direct and timely receipt and review. However, they also provide a mailing address and email for patient safety reports.
Remember, you have the right to file a complaint anonymously if you wish. Hospitals are mandated to establish a patient grievance process that ensures your rights as a patient are protected.
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What to do if you got the wrong medication
If you have received the wrong medication from a hospital, it is important to take immediate action to minimise any potential harm. Here are some steps you can take:
Seek Medical Attention:
If you realise that you have been given the wrong medication, it is crucial that you seek medical attention right away. Contact your doctor or pharmacist, explain the situation, and follow their advice. They will be able to guide you on the next steps and advise you on any potential risks associated with taking the incorrect medication.
Report the Error:
It is important to report the medication error to the appropriate authorities within the hospital. Express your concerns to the nurses or doctors involved in your care, and confirm that you are receiving the correct medication and dosage going forward. You can also contact the hospital's patient safety or quality improvement department to file a formal complaint or grievance. Additionally, you may report the error to external organisations, such as the Institute for Safe Medication Practices (ISMP), to help prevent similar mistakes in the future.
Document and Preserve Evidence:
Keep the medication, its original packaging, and any instructions, as these will serve as valuable evidence if you decide to take legal action. Make sure to document all relevant information, including the medication name, the date and time of the incident, and any communications or interactions with hospital staff regarding the error.
Consult a Lawyer:
If you believe you have suffered harm or adverse effects due to the medication error, consider consulting an experienced medical malpractice lawyer. They can help you understand your legal rights, establish negligence or breach of duty of care, and guide you through the process of seeking compensation or justice.
Prevent Future Errors:
Medication errors can often be prevented through various measures. Encourage the hospital to implement computerized medication order entry systems, clinical decision support systems, and alerts for high-risk medications. Additionally, medication reconciliation, which involves documenting a definitive list of a patient's current medications, can help reduce the risk of errors, especially in hospitals.
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Frequently asked questions
You should bring your complaints to your doctor and nurses as soon as possible.
Ask your doctor or the hospital's billing department to explain the charges, then find out how the hospital handles billing complaints and make your case.
You can file an appeal. You can also call 1-800-MEDICARE about billing questions.
Contact your state’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to submit a complaint.
You can file a complaint with the Joint Commission.
