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| Not Happy With Your Medical Care? You Have Rights |
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Not Happy With Your Medical Care? You Have Rights Source: Webster Senior Center News Author: Ellen Pothier, Beneficiary Outreach and Mediation Coordinator, Masspro Healthcare professionals try to provide the best care possible to their patients. However, sometimes Medicare beneficiaries or their family members are concerned or unhappy with the quality of care given. Examples of quality of care issues include a delay in services, treatment that was not ordered but should have been, unnecessary care, or a change in condition that was not propertly evaluated and/or treated. The Complaint Process If you are a Medicare beneficiary and are not satisfied with the quality of care you have received, call Medicare at 1-800-633-4227, or call Masspro Help Line at 1-800-252-5533. Trained complaint specialists are available to help you with your concern. Masspro will ask you to describe your complaint and will then send you a written summary. You have the right to add or to change the words in the summary to accurately describe your concerns. Masspro provides callers with referral information when it receives complaints that are outside of its review authority (e.g. billing questions). Your medical records will be obtained and reviewed by a doctor and a nurse, and the entire process can take up to 165 days. If Masspro finds that your care did not meet professionally recognized standards, it will work with your medical provider to develop a plan to improve the quality of care. Alternative Dispute Resolution Sometimes Masspro may not be able to find information about your concern in the medical record, or your concern may not be about the medical care you received. In these cases, alternative dispute resolution such as mediation or facilitated resolution may be an option. Mediation Mediation brings you and your healthcare provider together to talk about your conern. The goal is to meet face to face to reach a conclusion that you both agree on. An unbiased person trained in mediation leads these discussions. Facilitated Resolution Facilitated resolution does not involve direct contact between the healthcare provider and beneficiary. Instead, an unbiased expert acts as the "go-between", with all communication happening by phone. The goal is to provide an opportunity for you to voice your concerns and for your healthcare provider to improve the quality of care. Masspro wants to make sure that Mass. healthcare providers deliver care that meets professional standards. Your complaint helps Masspro identify problems and then improve the quality of care provided to Mass. Medicare beneficiaries. For more information, call the Masspro helpline at 1-800-252-5533.
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