Our Rights and Recourse - in USA

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What if I Am Not Satisified with My Care?

Provided by <A HREF= " http://health.yahoo.com/partners/ahrq.html " >Agency for

Healthcare Research and Quality</A>

Getting the best care and services means understanding how your health plan

works, what your rights are, and how to complain if you need to. You have the

right to get copies of test results as well as medical information about

yourself. If you are in a managed care plan, you can ask to change your primary

care

doctor if you are unhappy with the relationship. You may also be able to

switch plans during open enrollment.

Most plans have an appeals process that both you and your doctor may use if

you disagree with the plan's decisions. If your plan refuses to provide or pay

for services, you can complain or file a grievance about any decision you feel

is unfair–or you can appeal it.

You can contact the member services division of your plan for more

information or to complain. Use your plan's complaint process fully before

taking other

action.

Be sure to keep written records of:

All correspondence with the plan.

Claims forms and copies of bills.

Phone conversations–the date and time, the people you speak with, and the

nature of each call. If the plan does not satisfy you, you may decide to bring

the matter to the attention of your employee benefits manager, your State

insurance commissioner, your State department of health, or the legal system. If

you

are a Medicare or Medicaid beneficiary, you have additional ways through

those programs to file a grievance about the care received from a plan or

provider. For information, contact your State's medical Peer Review Organization

or

State Medicaid Program.