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2. Grievance: A written or verbal complaint by a patient or a patient’s representative regarding the patient’s
care, abuse or neglect, hospital compliance with the Medicare Conditions of Participation, or a Medicare
beneficiary billing complaint related to rights and limitations provided by 42 CFR 489.
i. Grievances may be filed during or after care, treatment or services provided.
ii. When uncertain, a complaint shall be treated as a grievance.
iii. Requests to treat a complaint as a formal complaint are considered a grievance.
iv. For the purposes of this policy, the following are considered grievances:
1. All written complaints pertaining to JDH inpatient and outpatient services, including
complaints about staff attitude and customer service.
2. Written complaints concerning UMG’s care provided, Medicare Conditions of Participation,
and abuse or neglect pertaining to the UMG medical practices are reviewed and responded
to through the formal grievance process as outlined in the procedures.
v. For the purposes of this policy, the following are NOT considered grievances:
1. Written or verbal complaints regarding UMG staff attitude, customer service, or scheduling
an appointment with the medical practices are reviewed and responded to directly by UMG
clinical practice leadership or designee.
2. Written or verbal billing complaints, concerns, or questions are not considered grievances
except for Medicare beneficiary billing complaints related to rights and limitations provided
by 42 CFR 489 and are reviewed and responded to directly by billing department leadership
or designee.
3. Written or verbal requests to obtain or amend medical records are reviewed and responded
to by Health Information Management department staff.
4. Letters attached to patient satisfaction surveys are not considered a grievances unless the
patient requests a response or provides identification.
3. Grievance Committee: Designated persons by the CEO UConn Health and Executive VP for Health Affairs via
charter to review patient grievances as appropriate in a manner that complies with the Medicare Conditions
of Participation requirements.
F. MATERIAL(S) NEEDED :
None
G. PROCEDURE :
1. Report the Complaint/Grievance:
i. To resolve an issue as soon as possible, staff should first discuss with a manager or supervisor.
ii. If a patient or their representative remains dissatisfied, or requests to file a formal complaint or
grievance, staff or manager should refer to Patient Relations.
iii. Patient Relations staff communicates directly with patient or representative via phone, in person
visit or email.
2. Patient Relations conducts Grievance Review and Response as follows:
i. Verifies permission to communicate (PTC) as appropriate.
1. If no PTC is available, a PTC is requested from the patient or representative via in person,
email or mail.
ii. Sends a written (email/mail) acknowledgement to the patient or patient’s representative within 7
business days of receipt of written grievance and/or conversation with patient or representative.
1. Date of receipt is considered day one, next business day if weekend or holiday.
iii. Sends written grievance (letter/email/summary) to appropriate leadership and the Grievance
Committee.