Tessa Quinn
If you have a complaint about a hospital, the first step is to bring your concerns to the hospital staff involved in your care, such as your doctor or nurse, and ask how your complaint can be resolved. You can also speak to a hospital social worker or the facility's management team or Patient Advocate, who can provide information about the hospital's complaint procedure. If you have concerns about billing, you should first ask the hospital's billing department to explain the charges and find out how the hospital handles billing complaints. If you have Medicare, you can file an appeal about billing or care quality issues. You can also contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care from a Medicare provider, or file a complaint on Medicare.gov. Outside of Medicare, you can file a complaint about a hospital with your state's Department of Public Health or Health and Human Services department, which may have a 24-hour consumer complaint line. Some states, like Massachusetts, provide a video in sign language with information on filing a complaint. If your complaint is about a specific incident, you may need to submit it in writing.
| Characteristics | Values |
|---|---|
| Who to complain to | The facility's management team or Patient Advocate |
| The hospital discharge planner | |
| The Joint Commission | |
| State Health and Human Services department | |
| CMS | |
| TJC | |
| Medicare | |
| State's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) | |
| How to complain | In writing |
| Verbally | |
| Online submission form | |
| Phone | |
| Fax |
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What You'll Learn
- Complain to the hospital's management team or Patient Advocate
- Contact your state's Beneficiary and Family Centered Care Quality Improvement Organisation (BFCC-QIO)
- File a complaint with the Joint Commission
- Contact your state's Health and Human Services department
- Submit a written complaint to the hospital
Complain to the hospital's management team or Patient Advocate
If you have a complaint about a hospital, it is recommended that you first register your complaint with the facility's management team or Patient Advocate. Any member of the management team should be able to provide information about the facility's complaint procedure. Their contact details can be obtained from the facility's administrative staff. If your complaint is about a person, facility, or issue outside their jurisdiction, direct your complaint to the correct agency.
If you are a patient, consumer, or their representative, you may need to complete a Health Insurance Portability and Accountability Act (HIPAA) form. You can obtain this form from the facility's administrative staff and submit it along with your written complaint. Putting your complaint in writing ensures that the formal complaint reflects your concerns and is in your own words. If you are unable to submit a written complaint, many hospitals offer a 24-hour consumer complaint hotline.
Before submitting your complaint, it is important to understand the hospital's complaint procedure. This includes knowing the response times, staff responsibilities, and prescribed actions. Additionally, be prepared to provide specific details about your complaint, including dates, times, and any relevant correspondence or discussions. It is also advisable to keep a personal record of your attempts to address your concerns, as it can help protect you in case of any retaliation.
If your complaint pertains specifically to patient safety, you can report it to the Joint Commission, which investigates patient safety concerns in accredited healthcare organizations. You can submit your concern through their online submission form or by calling their designated phone number. Alternatively, you can contact your state's Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care from a Medicare provider.
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Contact your state's Beneficiary and Family Centered Care Quality Improvement Organisation (BFCC-QIO)
If you have a complaint about the quality of care you received from a Medicare provider, you can contact your state's Beneficiary and Family Centered Care Quality Improvement Organisation (BFCC-QIO). The BFCC-QIO is a group of health quality experts, providers, and consumers organised to improve the quality of care delivered to people with Medicare. They can help with complaints about incorrect medication, incorrect surgery or treatment, or early discharge.
You can submit a complaint to your BFCC-QIO by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-468-2048. You can also contact your BFCC-QIO for help in filing an appeal if you think your coverage is ending too soon. For example, if you disagree with your hospital's decision to discharge you.
If you have a complaint about billing, you can also call 1-800-MEDICARE. Make sure you have the date of service, the total charge in question, and the name of your doctor and hospital. You can also contact your doctor or the hospital's billing department to explain the charges and find out how the hospital handles billing complaints.
In addition to contacting your state's BFCC-QIO, you may want to reach out to other organisations. These include your state's Health and Human Services department, CMS, and TJC (Joint Commission). The Joint Commission investigates complaints about patient rights and patient safety events. You can submit a concern through their online submission form or by calling 1.800.994.6610.
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File a complaint with the Joint Commission
If you have a patient safety concern or complaint about a health care organization accredited by the Joint Commission, you can submit your concern through their online submission form, which allows for direct and timely receipt and review of your concerns. The Joint Commission is not a healthcare provider, so in case of a medical emergency, you should call 911. If you are experiencing a mental health crisis, call 988 for the Suicide and Crisis Lifeline.
You can also report a patient safety event or concern over the phone by calling 1-800-994-6610. Note that the Joint Commission cannot accept faxed or emailed submissions, nor can they accept copies of medical records, photos, billing invoices, or other related personal information.
The Joint Commission is hospital patient care accreditation, and they are taken seriously by hospital administrations. They are a good place to start when reporting a hospital, along with your state Health and Human Services department and CMS. TJC complaints require a response within a certain timeframe, including an investigation.
If you are a hospital employee, you may face the risk of retaliation for reporting your hospital. It is recommended that you email yourself a history of your attempts to raise concerns about patient safety, including the times, dates, and actions taken, so that there is a clear record of your attempts to address these issues.
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Contact your state's Health and Human Services department
If you have a complaint about a hospital risk manager, you can contact your state's Health and Human Services department (HHS). The HHS is responsible for investigating complaints regarding the conditions at a healthcare facility and the actions of unlicensed personnel working at these facilities.
Each state's HHS department may have different procedures for submitting a complaint, so it is important to review the specific guidelines for your state. Some states, like Texas, offer multiple ways to file a complaint, including online, by phone, or in writing. Texas also has a dedicated hotline for reporting fraud, waste, or abuse in health and human services programs.
When filing a complaint, be sure to include as much detail as possible about the incident, including dates, times, and any relevant correspondence. It is also important to prioritize your complaint based on its content, immediacy, and the risk of the allegation. In cases of imminent danger, HHS must investigate within 24 hours for long-term care providers and within 48 hours for hospitals and other providers that don't provide long-term care.
Keep in mind that not all complaints will result in an investigation due to the high volume of submissions. However, all reports are important in helping to identify and address potential issues within the healthcare system.
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Submit a written complaint to the hospital
If you have concerns about the quality of care or other services you received at a hospital, you can submit a written complaint. Here are some steps you can take to submit a written complaint effectively:
Identify the Appropriate Channel
Hospitals typically have designated procedures for handling patient complaints. Before submitting your written complaint, take some time to understand the hospital's complaint process. You can usually find this information on the hospital's website or by contacting their patient services or administrative department. Understanding the proper channels will ensure your complaint is directed to the right people and increases the likelihood of a timely response.
Document Your Experience
Maintain a detailed record of your experience, including dates, times, names of individuals involved, and specific issues or incidents. This documentation will be crucial when you submit your written complaint. It will help you provide a clear and chronological account of your experience, making it easier for the hospital to understand and address your concerns effectively.
Prepare Your Written Complaint
When drafting your written complaint, be as specific and concise as possible. Clearly state the nature of your complaint, providing relevant dates, times, and names of individuals involved. Describe the impact the issue has had on you or your loved ones. You may also want to suggest potential solutions or outcomes you hope to achieve by submitting the complaint. Remember to maintain a respectful tone throughout your correspondence.
Submit Your Complaint
Once you have prepared your written complaint, submit it to the appropriate department or individual within the hospital. You can usually submit your complaint by mail or email, depending on the hospital's preferred method of communication. Keep a copy of your written complaint for your records, including any supporting documentation.
Follow Up
After submitting your written complaint, the hospital should acknowledge its receipt and provide you with a timeframe for their response. If you do not receive an acknowledgment within a reasonable amount of time (usually a few weeks), follow up with the hospital to ensure your complaint has been received and is being addressed. You can do this by contacting the hospital's patient services or administrative department and providing them with your complaint reference number, if applicable.
It's important to remember that hospitals take patient complaints seriously and are committed to addressing them appropriately. Your feedback is valuable and can help improve the quality of care for yourself and others. By following these steps, you can effectively submit a written complaint to the hospital and contribute to continuous improvement in healthcare services.
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Frequently asked questions
If you have concerns about the quality of care you received at a hospital, you can file a complaint with the hospital's management team or patient advocate. You can also contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) or submit a complaint online or over the phone to the Joint Commission.
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 disagree with your bill, you can file an appeal or call 1-800-MEDICARE about billing questions.
If your complaint is about an abortion facility, you must submit it in writing and you may not remain anonymous in accordance with Texas Administrative Code Title 26, Chapter 504, Rule 504.31(c)(2). You can submit your complaint by mail to the Health and Human Services Commission Complaint and Incident Intake in Austin, Texas. Alternatively, you can email HHSC INFOHFLC to submit a complaint against a Health Care Regulation staff member.
