Medical Complaint Resolution
To resolve problems with a medical insurance company:
If you are a patient with concerns about delayed insurance reimbursement, payments or issues regarding covered benefits, which are not related to the satisfaction of medical care that was received from a doctor or health provider, then your complaint should be directed first to the insurance carrier. Many insurance companies also have Provider Relations or Customer Service departments to help settle disputes. Telephone numbers are usually located on the back of your insurance card. If you get no satisfaction and still feel your complaint is legitimate, then contact the:
Colorado Department of Regulatory Agencies
Division of Insurance
http://www.dora.state.co.us/insurance/index.htm
The Division of Insurance licenses all insurance companies doing business in
the state of Colorado, but is limited to handling complaints regarding insurance
matters only.
To resolve problems with a hospital:
Most hospitals have patient representatives which should be your first contact when trying to resolve problems which are related to satisfaction with health care received at a hospital or medical care facility. If the problem cannot be resolved at that level contact the Colorado Hospital and Health Association at http://www.cha.com/. Again, this is related to the care received at the facility, but not about the care provided by an individual physician.
To resolve problems regarding an individual physician's care:
If the physician is a member of the Denver Medical Society, the society's Patient and Physician Relations Committee (PPR) will look into any patient's complaint if it is within its jurisdiction. Click here, Physician Finder, to verify membership. You are encouraged to try to resolve the problem directly with the doctor or his or her staff. If, after your best efforts, the problem is still not resolved to your satisfaction, you may file the complaint with the DMS grievance committee. All complaints must be in writing and faxed to (303) 331-9830 or mailed to:
Patient and Physician Relations Committee
Denver Medical Society
1850 Williams Street
Denver, CO 80218
The complaint letter must include the name and address of the physician, a description
of the grievance, what you want the Committee to do, and the signature of the
patient or the patient's legal guardian. The medical release form, when completed,
allows us to obtain your medical records and permits your physician to speak
to us about the complaint. Medical
Release Form
The Patient and Physician Relations Committee cannot become involved in a mediation case if a patient retains legal counsel or if the complaint is being reviewed by the Colorado State Board of Medical Examiners.
The Colorado State Board of Medical Examiners is responsible for licensing Colorado physicians. All patients have the right to file a complaint with the State Board. They can be contacted at:
State Board of Medical Examiners
1560 Broadway
Denver, CO 82020
Telephone: (303) 894-7690
Website: www.dora.state.co.us/ (Click
"Division of Registrations" which displays all the licensed occupations,
including "physician").
Denver Medical Society 1850 Williams Street Denver,
CO 80218
Phone: (303) 377-1850 Fax: (303) 331-9839 Email: dms@denvermedsociety.org