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| | MEDICARE CONSUMERS AND THEIR CAREGIVERS |
| | Doctors and other people working in healthcare strive to provide the best possible care. However, you or your caregiver may have a concern about the care you received. Healthcare Quality Strategies, Inc., (HQSI) encourages you to voice your concerns. You or your authorized healthcare representative have a right to file a quality of care complaint. (An authorized healthcare representative is a person you choose to help you with your medical decisions.) Types of Concerns Quality of care concerns are situations in which you believe harm was done. Some examples are:  | Being given the wrong medicine or the wrong dose |
| | Being given the wrong treatment or a treatment that you did not need |
| | Being discharged from the hospital too soon |
| | Not receiving complete discharge instructions |
| | Experiencing a delay in needed healthcare services |
| | Receiving inadequate care or treatment |
| | The date(s) care was received |
How to File a Complaint Calling HQSI Talk to HQSI about your quality of care complaint. This service is free for people with Medicare. | | Call our Medicare Beneficiary Helpline at 1-800-624-4557. (TTY users should call 1-800-752-8420.) |
| | Helpline hours are from 8:30 am to 5:00 pm, Monday through Friday |
| | You can leave a message after hours, and an HQSI associate will get back to you the next business day |
Have the following information ready when you call: | | The name on the Medicare card, date of birth, and Medicare number |
| | The Medicare beneficiary’s complete address and phone number |
| | The name and address of the doctor or healthcare facility |
| | Medicare health plan name and membership information if enrolled in a Medicare Advantage or other Medicare Managed Care plan |
| | If appropriate, the name and address of the authorized healthcare representative. (An authorized healthcare representative is a person you choose to help you with your medical decisions.) |
Our trained staff will listen to your concern and answer your questions. You will need to file a quality of care complaint in writing. An HQSI staff member can assist you with completing the paperwork (Quality of Care Complaint form) over the phone and send it to you for your comments and signature. Complaint Process When we receive your signed Quality of Care Complaint form, a case manager will be assigned to your case. The case manager will keep you updated on the complaint status. | | HQSI will request a copy of your medical record from a doctor or healthcare facility. A medical record is the documentation of your medical history or care. |
| | An HQSI physician reviewer reviews your medical record. The reviewer is impartial and does not have a relationship with the doctor or facility mentioned in your complaint. |
| | The reviewer will determine whether the care you received met professionally or medically recognized standards of care. (Professionally or medically recognized standards of care evaluate use of guidelines, judgment about how these guidelines best apply to the treatment that you received, and the avoidance of harm.)
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| | The review process can take up to 85 days. If HQSI has questions about your care after we review your record, we may need more information or more medical records to help us make a decision. This could bring the process to 165 days.
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Outcome of a Complaint At the end of the review, HQSI may only be able to tell you if the care you received met professionally or medically recognized standards of care. If your care did not meet standards, we will work closely with the doctor or facility so future care can improve. | | Federal law does not allow us to tell you more without your doctor's consent. |
| | Your case manager will keep you updated throughout the entire process. HQSI will contact you by letter about the final decision.
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By law, HQSI is allowed to base our review on your medical record only. Medical record review is limited. If information about your concern is not in your record, we will not be able to determine whether your care met professionally or medically recognized standards. HQSI may determine your case is suitable for Mediation if there are no quality issues with your care. Mediation is a free service. It brings you together with the doctor and/or healthcare facility. Your authorized healthcare representative can be in the meeting. A neutral third party (a mediator) leads the meeting. Mediation is another way to resolve your complaint. | |
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