Medicare Mediation Program

The Medicare Mediation Program is a way for Medicare beneficiaries or their representatives to work out quality of care concerns with their doctor and/or health care provider. Mediation may be offered if the case meets certain guidelines as determined by an IPRO physician.

Mediation has been used successfully in areas such as labor relations, environmental disputes, racial and ethnic conflicts, and personal disputes. Based on favorable results from a pilot study, the Centers for Medicare & Medicaid Services introduced mediation to the Medicare program nationwide in September 2003. Complaints that do not exhibit significant clinical quality of care concerns may be considered for mediation.

How does mediation work?

Mediation is an option for resolving a quality of care complaint under Medicare, at no direct cost to you. It is a dialogue or conversation between you and your doctor or hospital, facilitated by an impartial third person (the mediator). It is an opportunity for you and your doctor or hospital to tell your story, respond to each other, and resolve your concerns about the way you were treated.

How will I know if my complaint is appropriate for mediation?

Not all complaints are appropriate for mediation. An IPRO physician reviewer decides whether the case is suitable for the mediation process.

What is a mediation session like?

The session is led or facilitated by a professional third person (the mediator).
The session is usually face-to-face, but can also be conducted by telephone. It can take from two to four hours.
The session is strictly confidential. The session is not documented and cannot be used in any legal proceedings.
You and your physician or provider determine the solution to your complaint.

Can I bring someone with me to the mediation session?

Yes, if agreed to by the other party (provider), you may bring a family member or designated representative to the mediation session. You may also be provided with a mediation advisor, a trained professional who can answer your questions about the mediation process.

How will mediation affect my relationship with my doctor or health care plan?

People who participate in mediation often report improved relationships after the mediation session. If your doctor or provider agrees to participate, he or she is also committed to improving communication.

If I have a complaint and am interested in the mediation option, what should I do?

For information about the Beneficiary Complaint Response Program call 1-800-MEDICARE (1-800-633-4227). Or, visit the Centers for Medicare & Medicaid Services (CMS) Web site at www.medicare.gov.

If you are referred to IPRO, you will be provided with more information about the beneficiary response process options, including mediation. Keep in mind that not all complaints are suitable for mediation and that you and your doctor or provider must agree to mediation before going forward.

Please note: The use of mediation to resolve a complaint is voluntary. If you choose not to participate, your benefits under Medicare are not affected.