How to Resolve a Complaint with Doctors, Hospitals, or other Healthcare Providers
Have you been the victim of medical malpractice, neglect, breach of ethics, or unreasonable
charges? These problems and others are all too common in today’s healthcare system.
Fortunately, with the right preparation and approach many complaints can be resolved
simply and effectively between you and the offending party—without lawsuits, mediators,
or other intervention. Why? Because cooperating with you and finding common ground
is far more appealing than the expense and potential damage to professional reputation
that may come if you’re not satisfied.
This How-to offers guidelines for resolving your own disputes with healthcare providers,
and shows how PeopleClaim's online dispute resolution system can help you get the
results you're looking for.
Common complaints against healthcare providers
- Inability to access primary or specialty doctors
- Excessive wait time
- Practitioner physically or mentally unable to practice safely
- Practitioner incompetence
- Failure to communicate or interpret test results
- Overprescribing or inappropriate prescribing of medication
- Unprofessional conduct
- Practicing without a license
- Billing disputes, including overcharges and fraudulent billing
- Denial of insurance benefits
- Slow pay by medical insurers
- False or misleading advertising
To begin: Know your rights.
Some of your rights are guaranteed by federal law (HIPAA), some by state law (Medical
Practice Acts); others are backed by medical association codes of ethics, hospital
and clinic patient bills of rights, or by the rules of governing or licensing boards.
Among your rights are the following:
- a right to adequate health care
- timely treatment, including medical emergencies
- being treated with courtesy, respect, and dignity
- full disclosure of your medical condition by your doctor
- keeping your medical information private
- communication with your doctor about risks and benefits of treatments
- being provided with enough information to make informed choices about recommended
treatment (“informed consent”)
- the right to a second opinion about treatment recommendations
- the right to decide whether to follow a doctor’s recommendation
- a right to detailed information about costs
- access to your medical records
- a right to complain or report a problem or file a complaint without being sued
in retaliation
The doctors, clinics, and hospitals you use can provide specific information on
the patient rights they guarantee; your state’s medical board or public health department
will have additional information, as will the professional societies for specialized
medical fields, for example, psychiatry or plastic surgery.
Next: Talk to the healthcare provider.
Many complaints can be resolved directly with the provider, without need to escalate
to a formal complaint via state health authorities or a lawsuit. Clearing up a miscommunication
or misunderstanding may be enough to resolve your difficulty. Tip: It's a good idea
to tell the other party about your problem in person or by phone, and also in writing.
How PeopleClaim can help: Filing your complaint online at PeopleClaim.com
is a convenient way to put it in writing and get it to your healthcare provider
immediately. Or, if you've already contacted them but are not making progress, filing
a PeopleClaim can add extra pressure and urgency to give your complaint attention.
Do’s and Don’ts
DO:
- Ask questions about treatment recommendations and procedures, and make sure you
get answers you understand. Take as much time as you need. Remember, doctors and
other healthcare providers work for you.
- Keep a record. Make note of the start and end dates of your relationship with
the provider, and any significant events. Obtain copies of your medical records,
including physician’s chart notes if inpatient treatment is involved. (This is one
of your rights.) Take notes while on the phone with the doctor’s office, hospital,
billing department, or other contact points involving your case. Tip: Using
a recording device will help you preserve your legal rights if facts or statements
are in question. Save all written correspondence, including email messages. Record
names of witnesses and their contact info.
- Get a second (or third) opinion when disputing a practitioner’s advice, conduct,
or treatment.
- Make it clear that you know your rights.
- Find out what the treatment codes on your bills mean. Tip: It’s been estimated
that as many as 30% of medical bills include at least one coding error.
- Report suspected Medicare/Medicaid fraud. (Remember, everybody foots the bill
for these abuses.)
- Listen. Make an effort to understand the other side’s argument and constraints.
Be constructive and act in good faith.
How PeopleClaim can help: PeopleClaim's online process helps you state
your complaint and assemble all relevant facts: you can attach text documents or
photos, supply names of witnesses, and even have the system make a timeline for
you.
DON'T:
- Do not threaten or overstate your case.
- Do not defame the other party. Be truthful and avoid inflammatory words like "quack,"
"butcher," “incompetent,” or other words that aren’t necessary to your complaint.
- Don’t delay questioning any bills you dispute. The window during which insurers
will consider your appeal is generally 30-60 days. Note: the healthcare industry
is an active user of collection services, so make sure you stay on top of any amounts
owed and have a payment plan in place if you need one.
Add some extra oomph to your complaint
PeopleClaim offers an arsenal of optional services to get the attention of the other
party and help get your problem resolved.
- Choose PeopleClaim’s Public Posting option. Your complaint will post on
the Internet if it’s not settled in 10 days.
- Bring your case to the attention of relevant government regulators, independent
watchdogs, and media. For example, by choosing this option your complaint we’d
get your complaint against a practitioner to the state medical board or health department,
to the state medical society, to your state Attorney General, to Quackwatch.org,
or to your local newspaper, depending on your case. Note: Filing a claim through
a state health department or medical board will require a separate process, which
you'll need to initiate and follow through on your own.
- Invite a free consultation from lawyers through PeopleClaim if you feel
your case may require legal help. (Contacting you is voluntary, and any further
engagement would be between you and the lawyer. PeopleClaim does not participate
in any fees you may agree to.)
Above: Invite lawyers to review your complaint.
Looking ahead: Before you choose a healthcare provider
Preventing disputes is even better than resolving disputes. It’s worth taking the
time to understand your alternatives when it comes to doctors, clinics, hospitals,
and other practitioners and facilities. Chances are better that you’ll have a positive
experience if you can avoid providers with numerous complaints against them. Here
are some places to check:
Practitioners
-
County Medical Societies. These local physicians’ professional organizations
offer referral services. Doctors must meet certain professional standards to be
admitted and remain in good standing.
-
Hospital Administrators. Hospitals can tell you which doctors have privileges
to practice at their facilities. They may be able to tell you if a particular doctor
has had hospital privileges revoked.
-
Your state’s Medical Board and Licensing Board. State medical and licensing
boards control disciplinary actions against doctors. Certain records are available
to the public.
All Providers
-
Your state’s Department of Health. State Departments of Health act as clearinghouses
for information and enforcement of state law relative to a wide range of practitioners
and facilities. You can find complaint and other information for evaluating providers,
much of it online.
-
PeopleClaim. It’s easy to check any healthcare provider online at PeopleClaim.
You can review healthcare providers by category to see if any have PeopleClaims
filed against them. You can also search a specific provider by name or location.