Here is a question we received from one of our members: Our office received a grievance letter from a health plan against a physician in the office. A written response is requested. What do we do?
First, confirm who is asking for the written response. An inquiry letter from the Medical Board of California (MBC) is different than a health plan grievance. A MBC letter should be referred immediately to CAP's Med Defense Program Coordinator at 800-252-0555.
Second, although responding to any grievance may be unpleasant, the physician's cogent response with clear, objective facts is vital. The grievance process was designed to address genuine patient safety concerns of plan enrollees. The patient may have misinterpreted the clinical situation or misunderstood the follow-up plan.
Grievances against a physician may include:
- "I received poor care."
- "I was treated rudely."
- "I had to wait too long for an appointment."
However, if the grievance involves an unexpected outcome or "adverse event," you may contact CAP Cares at 800-252-0555. In either case, the physician, not the medical assistant, should draft the response to confirm the accuracy of the clinical facts. A response could include:
A brief, responsive opening line
Chronology of the medically relevant care given, including:
Treatment plan including:
Maintain a professional demeanor and respectful tone throughout the letter. Close by including your telephone number for any questions.
Authored byGeorgia McCullough, RN, JD
Risk Management & Patient Safety Department
If you have questions about this article, please use the "Contact Us" button to the left.
