Show #437 Airing Sunday, 6/15/08
Here’s the scenario: Your loved one is receiving health care services and you think the care is sub par. How do you make things right without jeopardizing their treatment? You could file a lawsuit, but that’s difficult and time consuming. Medicare recipients are given other options. Here to explain is Jennifer Bitterman, review director for Ohio KePRO.
Question: If we feel that the healthcare we or a loved one is receiving is not up to the proper standard of care, what are our options?
Answer: There are now several options available to Medicare Beneficiaries. We’ve talked about the first option before on Golden Opportunities: a Medical Record Review. Here, the medical records are examined to assess whether the care was sub par.
A second option, called Alternative Dispute Resolution, goes a little further. Ohio KePRO, in this case, acts as a neutral facilitator. Medical records, as always, will be looked at, but in this process Ohio KePRO also will sit with the beneficiary to review what his/her complaint entails. We will then call the provider to discuss what occurred. At this point, Ohio KeRPO may call the beneficiary back to further explain their case to them. If still not resolved, Ohio KePRO may recommend the third option, Mediation.
At Mediation, both sides agree to sit down together with a professional mediator to sort through the problem. As always, the medical records will still be reviewed to see if level-of-care obligations are being fulfilled.
Question: What is the goal of Mediation?
Answer: The goal of mediation is not to assign blame, but to try to better understand what is going on or has happened and to make improvements. Providers really do need to hear constructive patient feedback, and many times that does not happen. Patients either do not speak up or wait until they are too angry to be constructive.
Sometimes, the beneficiary has misconceptions of how something should be, and just needs further education. Other times, a problem can be identified on the provider’s side and all can work together to make improvements.
Question: How do we bring a complaint to Ohio KePRO's attention?
Answer: You would call Ohio KePRO—we’ll give the number at the end of the segment. You will be asked your name, the dates of your healthcare service, and your provider. We’d then have a detailed discussion on your concerns. At the end, you would be asked to sign a paper stating that these are your concerns, and that you’d like for them to be investigated.
Question: Do you need to have an attorney if you decide on mediation?
Answer: No, you do not. Actually, in this kind of mediation, everyone has to agree to who will be at the table. If a beneficiary wants his/her attorney there, the provider will have to agree to his/her presence. If all is agreed upon, KePRO is fine with it.
Question: Who pays for the mediation process?
Answer: Medicare pays for the mediation.
Question: How can our viewers learn more?
Answer: If you’re not ready to file a complaint but would like more information, call us to receive a “Know Your Rights” kit, to further explain the review process and to tell you the rights of Medicare beneficiaries.
If you’re concerned about the healthcare a spouse or parent is receiving, call Ohio KePRO to see if mediation might be the right choice. The phone number is next. My thanks to Jennifer Bitterman
