Tessa Quinn
If you have concerns about the quality of care or other services received at a hospital, you can file a complaint. This can be done by first bringing your complaints to the attention of the relevant doctor or nurse, and then escalating the issue to a hospital social worker if it is not resolved. If you have Medicare and disagree with your bill, you can file an appeal. If you received the wrong medication, had the wrong surgery or treatment, or were discharged too early, you can submit a complaint to 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 stay at the hospital or had issues receiving the correct medication.
| Characteristics | Values |
|---|---|
| Who to complain to | Doctor, nurses, hospital social worker, hospital billing department, hospital discharge planner, BFCC-QIO, Joint Commission, Medicare |
| What to complain about | Quality of care, refusal to cover a service, supply, or prescription, billing issues, getting the wrong medication, having the wrong surgery or treatment, getting discharged too early, getting an infection while in hospital |
| How to complain | In person, over the phone, by mail, online |
| What to include in the complaint | As much information as possible, confirmation number, relevant documents |
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What You'll Learn
How to make a complaint about a bill
If you want to make a complaint about a hospital bill, there are a number of steps you can take. Firstly, ask your doctor or the hospital's billing department to explain the charges and find out how the hospital handles billing complaints. You can also call 1-800-MEDICARE for billing questions if you have Medicare. If you have concerns about the quality of care or other services, you can file a complaint or grievance. You can do this anonymously, and free local health insurance counseling is available from your local State Health Insurance Assistance Program (SHIP).
If you believe you were wrongly denied financial assistance, you may be able to file a complaint through a Hospital Bill Complaint Program. These programs investigate patient complaints about hospital financial assistance and debt collection policies, notices, and website requirements. They do not, however, have jurisdiction over general billing and fee disputes. The Hospital Bill Complaint Program can investigate complaints about a hospital's failure to provide written notice about its discount payment and charity care programs, or to follow proper procedures before sending medical debt to collections.
You can file a complaint about a hospital online through a Patient Complaint Portal, which allows you to track the status of your complaint. You can also print and mail a signed and completed Patient Complaint Form, along with copies of any supporting documents. If you want to give another person permission to help with your complaint, an Authorized Representative Form will need to be included. If you are in Texas, you can file a complaint with the Health Facility Compliance Unit at the Texas Health and Human Services Commission (HHSC), which will investigate claims of improper hospital billing.
If your insurance company or provider isn't following surprise billing rules, you can submit a complaint. You can also return to your submission to add additional documents if needed.
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How to complain about the quality of care
If you have concerns about the quality of care received at a hospital, there are several ways to address the issue and register a complaint. Here are some steps you can take:
Speak to Hospital Staff
Start by bringing your concerns to the relevant medical professionals, such as your doctor or nurses. Be specific about your complaint and ask how it can be resolved. You can also request to speak with a hospital social worker, who can help mediate and identify resources to address your concerns. Social workers can also assist with organising services and paperwork when leaving the hospital.
Contact the Relevant Organisations
Depending on your specific situation, you may need to contact different organisations. For instance, if you have concerns about the quality of care provided by a Medicare provider, you can submit a complaint to your state's Beneficiary and Family Centered Care Quality Improvement Organisation (BFCC-QIO). You can reach them by calling 1-800-MEDICARE (1-800-633-4227), and they handle issues such as incorrect medication or treatment, premature discharge, and more.
If you have concerns about patient safety or acquired infections during your hospital stay, you can file a complaint with the Joint Commission. They can be contacted online, by mail, or by phone, and you may need an incident number to report your issue.
Billing Complaints
If your complaint pertains to billing issues, first ask your doctor or the hospital's billing department to explain the charges. Then, understand the hospital's process for handling billing complaints and make your case. You can also file an appeal if you have Medicare and disagree with your bill. For billing questions, you can call 1-800-MEDICARE. Remember to have relevant details on hand, such as the date of service, the total charge in question, and the names of the doctor and hospital involved.
Provide Necessary Information
When filing a complaint, providing as much information as possible will help expedite the process. This includes any relevant documents, which can be added to your submission online or by mail. Keep a record of your confirmation number to easily reference and follow up on your complaint.
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Who to contact to make a complaint
If you have a complaint about a hospital, the first step is to bring it to the attention of your doctor or nurse. Ask them to explain the charges and find out how the hospital handles billing complaints. If you have Medicare, you can file an appeal about your bill. You can also call 1-800-MEDICARE with billing questions, or 1-877-468-2048 for TTY users.
If you have concerns about the quality of care you received, you can file a complaint with your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). You can submit a complaint to your BFCC-QIO for issues like receiving the wrong medication, having the wrong surgery or treatment, or being discharged too early. You can also find your BFCC-QIO by calling 1-800-MEDICARE (1-800-633-4227).
If you got an infection while in the hospital or had problems getting the correct medication, you can file a complaint with the Joint Commission by mail or online.
If you are in Florida, you can file a complaint with the Agency for Health Care Administration. If you are in New York, you can file a complaint with the New York State Department of Health.
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What to do if you have the wrong medication or treatment
If you have received the wrong medication or treatment, it is essential to take prompt action to address the issue and prevent any potential harm. Here are some steps you can take if you find yourself in this situation:
Identify the issue:
First, it is crucial to identify and confirm that you have received the wrong medication or treatment. This may involve checking your prescription, dosage, and medication administration records. If you have any concerns or suspicions, it is better to be cautious and seek clarification from a trusted healthcare professional.
Report the issue to hospital staff:
Once you have confirmed the issue, report it to your doctor, nurse, or another trusted member of the hospital staff as soon as possible. Be specific about the problem and ask how it can be resolved. It is important to advocate for yourself and ensure that the hospital staff takes your concerns seriously.
Seek support:
You can also ask to speak with a hospital social worker. Social workers are trained to help patients resolve issues and identify resources. They can provide valuable support and guidance throughout the process and help you navigate any challenges or complexities that may arise.
File a formal complaint:
If the issue is not resolved to your satisfaction or if you wish to make a formal record of the incident, you can file a complaint. In the United States, you can submit a complaint to your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for issues related to Medicare providers. You can also file a complaint with the Joint Commission, especially if you have concerns about patient safety or if you developed an infection during your hospital stay.
Contact a medical malpractice attorney:
If you or your loved one has suffered illness, injury, or other harmful consequences due to the medication or treatment error, you may want to consult a medical malpractice attorney. They can help you understand your legal rights and options for seeking compensation. It is important to act promptly, as time is often a critical factor in these situations.
Remember that medication and treatment errors can have serious consequences, and it is your right to receive proper care and attention when addressing these issues.
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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 feel safe and confident about leaving the hospital, so if you have any doubts or concerns, speak out. Communicate your worries to your doctor, and ask for clarification on your diagnosis, new treatments, medication changes, and any symptoms to monitor. If you don't feel comfortable approaching your doctor, you can also contact a patient advocate or your insurance company. They may be able to delay your discharge if needed.
Before leaving the hospital, ensure that you fully understand your medications and any changes made during your stay. Confirm the dose and schedule of any new medications and make sure a pharmacist or healthcare professional has explained which medications you need to start or stop taking. It is crucial that you feel confident in managing your medications once you return home.
Additionally, consider your caregiving needs. If you require assistance after your hospital stay, ensure that someone is available to help you. This could include arranging for a friend or family member to stay with you or seeking professional caregiving services. Make sure you have a plan in place to support your recovery and well-being.
If you feel that your concerns are not being addressed adequately, you can submit a complaint. Each hospital may have its own process for handling complaints, but you can start by bringing your concerns to the hospital's social worker, who can help resolve problems and identify resources. You can also contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to submit a complaint about the quality of care received from a Medicare provider, including early discharge. Remember, your health and safety are the top priorities, so don't hesitate to advocate for yourself and ensure that you feel ready and prepared for discharge.
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Frequently asked questions
First, 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.
If you have Medicare and you don’t agree with your bill, you can file an appeal. You can also call 1-800-MEDICARE about billing questions. Make sure you have the date of service, the total charge in question, and the name of your doctor and hospital.
Bring your complaints to your doctor and nurses as soon as possible. Be as specific as you can and ask how your complaint can be resolved. You can also ask to speak to a hospital social worker who can help solve problems and identify resources.
You can submit a complaint about New York State hospitals and diagnostic and treatment centres to the New York State Department of Health.
