Medicare Beneficiary Complaint Protocol & Complaint Form

Protocol for Resolving Complaints from Medicare Beneficiaries

The patient has the right to freely voice grievances and recommend changes in care of services without fear of reprisal or unreasonable interruption of services. Service, equipment, and billing complaints will be documented in the Medicare Beneficiaries Complaint Log, and completed forms will include the patient’s name, address, telephone number, and health insurance claim number, a summary of the complaint, the date it was received, the name of the person receiving the complaint, and a summary of actions taken to resolve the complaint.

All complaints will be handled in a professional manner. All logged complaints will be investigated, acted upon, and responded to in writing or be telephoned by a manager within a reasonable amount of time after the receipt of the complaint. If there is no satisfactory resolution of the complaint, the next level of management will be notified progressively and up to the CEO or Board of Control.

The patient will be informed of this complaint resolution protocol at the time of set-up of service.

Please CLICK BELOW for a printable Medicare Beneficiary Complaint Log form. Fill out the form in its entirety and mail it to the address on the form.