When your healthcare provider is to blame for something wrong that happened to you, there are avenues you can take to file a complaint. As you begin this process, it is important that you figure out who to speak with and how to do it.
You may want to file a grievance in any of the following situations:
If you like your healthcare provider overall but have a few complaints, it may make sense to provide feedback directly to your healthcare provider, along with your expectations. For example, if your healthcare provider has a great bedside manner but doesn’t return phone messages, you are more likely to get the results you want by explaining your concerns to your healthcare provider.
If you noticed an error in your medical record, but your medical care has been good, you should bring it up to the healthcare provider and office staff. They are highly likely to correct it to your satisfaction.
If you feel that were insulted by your healthcare provider, then you might be more comfortable talking to someone else on the team, such as your nurse, the physician assistant, or another healthcare provider. Sometimes another person can look at things objectively and can guide your healthcare provider to avoid repeating this problem—with you and with other patients. If the situation bothered you so much that you don’t want to see that healthcare provider again, be sure to tell the office staff why you won’t be using that healthcare provider’s services again.
On the other hand, if the insult or behavior was directed at you because of race, gender, sexual orientation, age, or religion, there are civil actions you can take, including contacting the Office for Civil Rights at the U. S. Department of Health and Human Services. If you suspect that there may have been illegal or unethical billing practices, including fraudulent billing, upcoding, and balance billing, then it is important to file an appeal with your health insurance company. If your appeal is denied, your healthcare provider may have a patient advocate that can help you free of charge. If you still can’t find a resolution, you can contact your State Insurance Commissioner. If a medical error resulted in personal injury, hospitalization, disability, diminished quality of life, or death, then it is important to report the matter to the hospital or practice manager. You will need to do so with an attorney if you are seeking damages or planning to litigate. If your healthcare provider was sexually inappropriate or abusive in any way, you should contact the state medical board and file a police report.
Keep your letter concise. The content should be no more than a few paragraphs, written in short sentences on a single page. Be specific about your complaints. If possible, use a bulleted list to punctuate your points.
Tell what action you would like to be taken. If you are reasonable in your expectations, then your complaint is more likely to be taken seriously. For example, if your healthcare provider overbilled you, then suggesting that the healthcare provider should be in jail can make you seem unreliable. If you ask for a refund, you are likely to receive it. Leave the legalities to the authorities. Get help if you are unable to express yourself. If you have trouble communicating what happened or what you want, ask a family member to help or consider hiring a patient advocate experienced in these matters.
Finally, don’t go in assuming that your efforts will be for naught.
If your complaint is appropriate and appropriately directed, the chances are good that it will be heard.
Hospitals, practice managers, government offices, and state medical boards investigate and record complaints, even those that are not deemed actionable. These agencies know that not all complaints are fair to healthcare providers. However, when multiple complaints are received and a pattern of behavior is established, serious action against the healthcare provider will be taken.
By evidencing inappropriate, illegal, or harmful behavior, you can help protect others from experiencing the same problem you experienced.
