Every day PHAN receives phone calls from people all over PA having trouble accessing healthcare services. Many people we talk to have already called their health plan and/or their County Assistance Office multiple times but have not been able to resolve their issue.
What many people don’t realize is that they have the right to file a complaint to their health plan or a state agency.
Filing a complaint or a grievance can sometimes help solve a problem when other methods have failed. Health Plans tend to take problems more seriously when a complaint has been filed or when a regulator from a state agency is involved.
Complaints don’t always lead to problems being solved. However, filing a complaint can help improve the healthcare system by letting state regulators know that your health plan is not meeting your needs. It also helps PHAN advocate for improvements to the system and ultimately helps everyone.
What Is a Complaint?
Healthcare providers and health insurance plans are regulated by state agencies such as the Department of Health (DOH), the Department of Human Services (DHS), and the PA Insurance Department (PID).
A complaint is a formal statement to a healthcare provider, a health plan, or a state agency identifying a problem and asking for a resolution.
State agencies have the power to enforce laws and regulations and are often a last resort when talking with the plan or the healthcare provider has failed to resolve the problem.
We Can Help!
PHAN helped Tammie S., a resident of Northumberland County, file a complaint with her health plan. Tammie is blind and her healthcare provider would not provide documents in an accessible format such as braille or an audio recording. After filing the complaint, Tammie’s health plan provided her with equipment and software so Tammie’s computer could scan and read documents to her.
PHAN helps Pennsylvania residents file complaints. In addition to helping people file the complaint, we follow up with state agencies to make sure they are acting on the complaint.
If you have an issue that you haven’t been able to resolve and would like to file a complaint, please contact PHAN’s help line by calling (877) 570-3642.
Part 2 of this post will cover when to consider filing a complaint and which organizations handle which types of complaints.
This publication is funded by the Pennsylvania Developmental Disabilities Council.