HMO Guide for Seniors - Office of the Patient Advocate - State of ...

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Customer Service/Quality of Care Problems
I
f you have a problem, start by talking to your doctor and your
Medicare HMO’s customer service department. Often you can
solve a problem this way. If this doesn’t help, you can take the
steps described below. You can also call HICAP.
Customer Service Problems
“Each time I
visited my doctor,
I had to wait 1
to 2 hours, even
though I had an
appointment. I
filed a grievance
with the HMO,
and now my
service is better.”
You can file a grievance with your Medicare HMO if you are
unhappy about the way you are treated, the equipment or the
facility you used, how long you have to wait for appointments,
or other customer service concerns.
You can also file a grievance if you have a problem with services
in a special benefit package you bought, such as dental care.
Ask your HMO to mail you a grievance form. Or get the form
on your HMO’s website.
Your HMO must take action within 30 days after it gets your
form. For help, call HICAP.
Quality of Care Problems
You can file a complaint with HSAG if you have a problem like these.
The government contracts with HSAG to help Medicare members.
You got the wrong
medicine or an overdose.
You had unnecessary
surgery or testing.
You had a delay in getting
a service.
You had inadequate care,
treatment, or discharge
instructions.
You got a misdiagnosis.
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