Consumers
Quality of Care Concerns
If you have a concern about, or are not satisfied with, the quality of care you received:
- Call Qualidigm toll-free at 1.800.553.7590 and describe your concern. A member of our staff will listen and help you decide if you want to make a formal complaint.
- If you decide you want to make a formal complaint, we can help you put it in writing. Once Qualidigm receives the written complaint, the quality of care review will begin.
- Your case may be suitable for an Alternative Dispute Resolution (ADR), a free service that enables Medicare beneficiaries to resolve concerns by talking directly with their doctor or provider of care within a neutral environment.
The Review Process
- A case manager will contact you once the complaint is filed and serve as your point of contact throughout the process.
- A physician reviewer will look at all aspects of care included in your medical record surrounding your complaint and will share the initial findings with the health care provider or facility your complaint is related to.
- The health care provider or facility also has the opportunity to comment. Qualidigm works directly with you and your provider to resolve the concern.
- The entire process may take three to six months for completion.
Examples of Quality of Care Concerns
- Medication issues - wrong medication, missed doses, administration errors.
- Unnecessary surgery/diagnostic testing.
- Delay in service.
- Inadequate care or treatment by any Medicare hospital staff or doctor.
- Premature discharge.
- Change in condition that was not treated or was misdiagnosed.
- Inadequate discharge instruction.
Call Qualidigm at 1.800.553.7590 if you:
- Wish to discuss the quality of care you received.
- Want to file a formal quality of care complaint.
Call 1.800.MEDICARE (1.800.633.4227) if you:
- Have general questions about Medicare coverage.
- Need clarification on how to enroll in Medicare.
- Have billing issues.
- Want more information about Medicare benefits and services.
- Need help understanding your Medicare rights.