Quality of Care Concerns
What should you do if you have a concern about, or are not satisfied with the quality of the care you received?
- Call IPRO at 1-800-331-7767 (or 1-866-446-3507 TTY for the hearing impaired) and describe your concern. One of our trained staff will listen and help you decide what to do. One of your choices is to make a formal complaint.
- If you decide you want to make a formal complaint, we can help you put it in writing. Once IPRO receives the written complaint, the quality of care review will begin.
Your case may be suitable for mediation, a free service for Medicare members which is an alternative to resolve your concerns by talking directly with your doctor.
Who conducts the review and what does it include?Depending on the case, any of our physician reviewers can review your complaint. (A physician reviewer is a practicing physician who works with IPRO to address quality of care concerns.) A case manager will contact you once the complaint is filed and serve as your point of contact throughout the process.
The physician reviewer looks at all aspects of care surrounding your complaint, and makes an initial finding that is shared with the health care provider or facility your complaint is related to. Your health care provider/facility also has the opportunity to comment. IPRO works directly with you and your provider to resolve the problem and make sure that you and other Medicare members receive the best care possible.
The entire process takes anywhere from three to six months.
How and when to contact usAn IPRO staff member is available Monday through Friday, 8:30 a.m. to 4:30 p.m. However, you can leave a message on the line any time of the day or night, Monday through Sunday.
Our toll-free number is 1-800-331-7767, and for the hearing impaired (TTY) is 1-866-446-3507.
Call IPRO at 1-800-331-7767 if:
- You wish to discuss the quality of care you receive
- You 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
- You need clarification on how to enroll in Medicare
- You wish to discuss billing issues
- You want to learn more about Medicare benefits and services
- You need help understanding your Medicare rights
- Medication issues - overdose, wrong medication, missed dose, administration errors
- Unnecessary surgery/diagnostic testing
- Delay in service
- Inadequate care or treatment by any Medicare hospital or doctor
- Premature discharge
- Change in condition that was not treated/misdiagnosis
- Inadequate discharge instruction
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