Sage-Tips

What is a quality of care grievance?

Quality of care grievances (complaints about the quality of care received in hospital or other provider settings) may be reported through the plan’s grievance procedures, the enrollee’s Beneficiary Family Centered Care – Quality Improvement Organization (BFCC-QIO), or both.

How do I file a complaint with OHA?

Submit the complaint in person or via mail to: Health License Office, 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301, fax: (503) 370-9216, or email: [email protected].

What is a complaint in health care?

Patient complaints usually refer to an ‘expression of grievance’ and ‘dispute within a health care setting’. 10 They are often formal letters written to a healthcare organisation (or regulator) after a threshold of dissatisfaction with care has been crossed. 11 Typically, complaints are made by patients or families.

What is an expedited grievance?

A grievance/appeal is expedited when a delay in decision-making may seriously jeopardize the life or health of a member or their ability to regain maximum function. This includes but is not limited to severe pain, potential loss of life, limb or major bodily function.

What is considered a grievance?

A grievance is generally defined as a claim by an employee that he or she is adversely affected by the misinterpretation or misapplication of a written company policy or collectively bargained agreement. To address grievances, employers typically implement a grievance procedure.

How do I report a nursing home to Oregon?

If you have a complaint about a nursing home, please call 1-877-280-4555 or email [email protected].

How do I file a complaint against a business in Oregon?

Contact Us

1. Toll-Free: 1-877-877-9392, 8:30 – 4:30, Monday-Friday.
2. Email: [email protected].
3. Fill out the online Consumer Complaint Form »

What is the most common reason for patient complaints?

The main reasons for complaints were related to attitude/conduct (28.8\%), professional skills (17.8\%), patient expectations (16.2\%), waiting time (10.0\%) and communication (7.8\%). Forty-three percent of complaints were evaluated as justifiable, 38\% not justifiable and 19\% inconclusive.

What is an exempt grievance?

“Exempt Grievance” means Grievances received over the telephone that are not coverage disputes, disputed health care services involving medical necessity or experimental or investigational treatment, and that are resolved by the close of the next business day.

How do I file a complaint against a home health agency?

If you have a complaint about the quality of care you’re getting from a home health agency, call the home health agency and ask to speak to the administrator. If you don’t believe your complaint has been resolved, call your state home health hotline.

How to file a complaint about improper care or unsafe conditions?

You may have a complaint about improper care (like claims of abuse to a nursing home resident) or unsafe conditions (like water damage or fire safety concerns). To file a complaint about improper care or unsafe conditions in a hospital, home health agency, hospice, or nursing home, contact your State Survey Agency.

How do I file a complaint against a hospital in California?

Filing a complaint through the California Health Facilities Information Database (Cal Health Find) is the most direct way. You file the complaint and it is routed directly to the district office that has oversight authority for the facility in question. Phone, Fax, or ​Mail Draft your own letter and mail or fax it in to the district office.

How do I file a complaint against a skilled nursing facility?

You may also file your complaint on-line through Cal Health Find by searching for the facility and selecting ‘File a Complaint’. Complaints against skilled nursing facilities and other long-term care (LTC) facilities that involve the threat of imminent danger, death, or serious bodily harm must be completed within 90 days.