Care Concerns
If you are troubled by the quality of a Medicare service, call 1-800-Medicare (1-800-633-4227). You will be directed to call us at Primaris. Experts at Primaris will review your medical records to determine if your care met professional standards.
Examples of quality of care concerns you might report are:
- Being given the wrong medication, or a medication to which you are allergic, or medications that interact in a negative way.
- Not receiving treatment after abnormal test results.
- Being given the wrong blood when a transfusion is ordered.
- Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
- Being improperly evaluated for a problem and because of this you did not receive the treatment you needed.
- Being given the wrong treatment or treatment that you did not need.
- Developing bed sores because you were not moved regularly.
Before calling the QIO, have this information handy:
- Name on Medicare card
- Medicare number
- Address
- Phone number
- Date of birth
- Name, address, and phone number for the health care provider
- Date the service was provided
During this call, you are asked questions that allow Primaris better understand your concern. We will ask you to send your concern to us in writing. We want to make sure nothing is missed and we don’t misinterpret what you are saying. Primaris then calls your health care provider to request your medical record.
QIOs use impartial doctors to review information in your medical record about your concern. These experts determine if there were any quality problems. These doctors see if the care given was necessary and if the right treatment was given. Since even good care or correct drugs can sometimes harm a patient, they also see if good judgment was used in deciding on your treatment and if risk to you could have been avoided.
The goal of the review isn’t to punish the provider. Instead, the goal is to help improve the quality of the medical care given to all future patients.
A typical review takes about three months. If the reviewer needs more time to answer questions about the care you received, the review can take up to twice that long.
At the end of the review, Primaris can tell you whether your care met approved standards. If the concern is about your doctor, federal law does not allow Primaris to tell you more without your doctor’s consent. If your medical care did not meet approved standards, Primaris works with your health care provider to develop a plan to improve care for future patients.
Often, poor communication is at the heart of patient concerns. When this is the case, Primaris can help you and your health care provider reach an understanding.
Medicare and organizations like Primaris help Medicare beneficiaries receive the right care. You can help improve health care by reporting your concerns to Medicare.
Remember: When Missourians have complaints about the quality of medical care they have received, they should call 1-800-MEDICARE. After an initial screening, they will be directed to Primaris toll-free at (800) 347-1016 Monday through Friday from 8:00 a.m. through 4:30 p.m. Central Standard Time.