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File a Complaint

Other Resources

Medicare's complaint-resolution process does not investigate issues related to unprofessional or impolite behavior, housekeeping, or the temperature of your room or food.

For help with these concerns, please review our list of suggested resources.

 

Not in Idaho or Washington?

If the care was provided outside of Idaho or Washington, please call 1-800-MEDICARE (1-800-633-4227, or TTY/TTD 1-877-486-2048 for the hearing and speech impaired) for assistance.

If your concern is

  1. related to the quality or necessity of care provided, and
     
  2. that care is covered by Medicare, and
     
  3. the care was provided in Idaho or Washington

then you may start our complaint process.

Please complete our form describing concerns about:


After we have received the completed complaint form, you will be assigned a case manager who will keep you updated throughout the entire process. However, please note that federal laws control the way we investigate and respond to your complaint. The law limits the amount of information we are allowed to share with you. Our findings are not allowable in court, and do not directly affect coverage, payment, or billing.

To address your quality-of-care concerns, we may perform a medical record review (see below), and/or offer alternative dispute resolution services.
 

Reviewing Your Medical Record

An independent physician (one who does not have a relationship with your healthcare provider or the place where you received care) will review your medical record and determine whether the care you received was similar to what would have been given to you by most healthcare providers. This is called “meeting professionally recognized standards.”

Our decision will be based on the information written in your medical record. We cannot do other kinds of investigation, such as interviews or site visits.

If there is not enough information documented in your medical record that relates to your concern, we will not be able to make a decision one way or the other. If we determine that your care did not meet professionally recognized standards, Qualis Health will work with your healthcare provider to make changes and improve future care.

For more information about Medicare's medical record review process, please see our brochure, What's Next? Understanding what happens after you file a quality-of-care complaint with Medicare.