Anatomy Of A Complaint

What is a quality of care concern?

Some examples of quality of care concerns you might report include:

• Being given the wrong medication.
• Not receiving treatment after abnormal test results.
• Being given the wrong blood when a transfusion is ordered.
• Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
• Being given the wrong treatment or unnecessary treatment.
• Developing pressure ulcers because you were not moved regularly.

What information do I need to provide during the phone call?

Before calling IPRO, have the following information handy:

• Name on Medicare Card.
• Medicare Number.
• Address.
• Telephone number.
• Date of birth.
• The health care provider's name, address, and telephone number.
• Date the service was provided.

What should I expect during the call?

During this call, you are asked questions that allow IPRO to better understand your concern. You will be asked to send information about your concern to IPRO in writing. If you cannot write your concerns, the review case manager dedicated to your case will help you write your letter. IPRO will then request a copy of your medical record from your health care provider.

What happens next?

IPRO uses impartial doctors to review information in your medical record and other correspondence about your concern. These experts check to see if there were any quality problems, determine if the care given was necessary and if the right treatment was given. Since even good care or correct drugs can sometimes harm a patient, they also see if good judgment was used in deciding on your treatment and if risk to you could have been avoided.

How long does the complaint process take?

A typical review takes about three months to complete. The review case manager dedicated to your will keep you updated on the progress of your case from start to finish.

What can I expect at the conclusion of the review?

At the end of the review, IPRO can tell you whether your care met approved standards. If the concern is about your doctor, federal rules do not allow IPRO to tell you more without your doctor's consent. If your medical care did not meet approved standards, IPRO works with your health care provider to develop a plan to improve care for future patients.

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