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.
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 regulatory authority to conduct an inspection based on your concerns, the complaint will be scheduled for inspection. If the information given leads us to believe that one or more residents are in any immediate danger, the field office will conduct an inspection within two business days.
If after assessment the Complaint Administration Unit determines that AHCA will not conduct an inspection at this time, 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. Due to the Health Insurance Portability and Accountability Act (HIPAA), we would have to remove all identifying information from your complaint, which limits the receiving department’s ability to effectively evaluate the information. We will give you the referral information and ask that you forward your concerns to that department, so the integrity of the complaint remains intact.
Although an inspection may not be conducted, your general concerns are kept on file and considered during future inspections.
If an inspection is conducted, you will be notified in writing of the outcome.
To file a complaint about a health maintenance organization (HMO):
You must first use and complete 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 Subscriber Assistance Program (SAP)