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WHAT HAPPENS WHEN I FILE A COMPLAINT?
To file a complaint against a doctor or other health care professional:
- When you contact our call center, tell our staff person that you wish to file a complaint against a health care professional.
- All complaints against health care professionals must be filed in writing.
- This Consumer Services link will explain the process in detail and answer many consumer questions, as well as allow you to download a complaint form.
To file a complaint against a health care facility:
- When you contact the call center, tell our staff person that you wish to
file a complaint against a facility.
- Your complaint can be filed anonymously, however if you wish to know the
results of your complaint, you should be prepared to give your name, address
and telephone number. This information will allow our surveyors to contact
you should they need additional information or clarification. This information
never becomes public information and cannot be released.
- Be prepared to give detailed information such as patient/resident names,
dates, times of events and where the event happened or is currently happening.
- After filing your complaint, it is immediately forwarded electronically
to our Complaint Administration Unit for review and priority assignment.
- If after assessment, it is determined that AHCA has the authority to investigate
your concerns, the complaint will be scheduled for investigation. If the information
given leads us to believe that one or more residents are in any immediate
danger, the field office will investigate your concerns within 48 hours.
- If after assessment the Complaint Administration Unit determines that AHCA
does not have authority to investigate your concerns, you will be notified
in writing of this determination and why. If another agency has authority
to look into your concerns, you will be notified that we have referred your
information to that agency.
- After the completion of the investigation, you will be notified in writing
of the results of that investigation.
If your facility complaint is a billing issue:
- You must file your complaint in writing. You can download this form
here.
- We have no authority to determine how much a facility can charge for
any service and cannot intervene in these matters.
To file a complaint about a health maintenance organization (HMO):
- You must first use the health maintenance organization's internal grievance process for your complaint before the agency can take action on your behalf. Many problems can be resolved by speaking to the HMO's member services office.
- If you are having problems with the internal procedures of your HMO, you can bring your complaint to the agency for "intervention".
- There are volunteer managed care ombudsman committees functioning in some areas of the state at the local level that may be able to assist you with your concerns and we can relay your issues to these local committees.
- If you have completed the internal grievance process with your HMO and the situation has not been resolved to your satisfaction, you may take your complaint to the Statewide Provider and Subscriber Assistance Program (SPSAP)
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