How can I complain about poor medical care I received in a hospital?
While you are in the hospital: If possible, first bring your complaints to your doctor and nurses. 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. Social workers also organize services and paperwork when patients leave the hospital.
If you are covered by Medicare, you can file a complaint about your care with your State's Quality Improvement Organization (QIO). These groups act on behalf of Medicare to address complaints about care provided to people covered by Medicare.
Typical complaints QIOs handle are getting the wrong medication, having the wrong surgery, or receiving inadequate treatment. You can also find your QIO by calling 1-800-MEDICARE.
If you get an infection while you are in the hospital or have problems getting the right medication, you can file a complaint with the Joint Commission. This group certifies many U.S. hospitals' safety and security practices and looks into complaints about patients' rights. It does not oversee medical care or how the hospital may bill you.
To find out what other patients had to say about their recent hospital stays, visit the Hospital Compare Web site. You'll find answers from patients about how well doctors and nurses communicated, how well patients' pain was controlled, and how patients rated their hospital.
If you are discharged before you're ready: This is a big concern for many patients because insurers balk at long hospital stays. Talk to the hospital discharge planner (often a social worker) if you don't think you're medically ready to leave the hospital. The discharge planner will take your concerns to the doctor who makes this decision.
If you are covered by Medicare or by a Medicare managed care plan, you can file an appeal about a discharge while you are still in the hospital. You should get a form from the hospital titled "An Important Message from Medicare," which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 to 3 days. The hospital cannot discharge you until the appeal is completed.
When you get your hospital bill: First, ask your doctor or the hospital's billing department to explain the charges. Find out how the hospital handles complaints about bills, and make your case. If you still have questions, you should contact the Medicare carrier that handles billing issues for your Medicare program.
You can also call 1-800-MEDICARE about billing questions. Make sure you have the date of service, total charge in question, and the name of your doctor and hospital.
Even with this information, it's not easy to be as assertive in a health care setting as it is in an auto repair shop or restaurant. But it's a smart move that can help you get the quality care that you deserve.
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Note: Excerpted/updated from a 2009 AHRQ Advice Column by Carolyn M. Clancy, M.D.: How to Complain--and Get Heard!
