Where to Complain About a Doctor or Your Medicare Care
It depends on the problem. Concerns about a doctor's license or conduct go to the state medical board. Concerns about the quality of care you got under Medicare go to Medicare's quality group, the BFCC-QIO. Problems with a Medicare plan go to the plan or Medicare. A refused claim is an appeal, not a complaint.
Complaint or Appeal?
Medicare.gov says to file a complaint, also called a grievance, if you have a problem with the quality of care you got, or with how a plan treats you. File an appeal if a plan refuses to cover a service, supply or prescription, or you got a bill for a claim you already submitted.
In an emergency call 911. In a mental health crisis call or text 988.
This guide explains how to find and check care. It can't tell you which doctor or treatment is right for you. Your doctor or plan can.
Who Handles What
| Problem | Where Medicare.gov and HHS say to go |
|---|---|
| A doctor's licensing or unprofessional conduct | Your state medical board. The FSMB board list links to each board's complaint page. |
| Quality of care from any provider, in any setting (except dialysis facilities) | The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Medicare.gov says it is run by Commence Health or Acentra, depending on your state. |
| Your Medicare health or drug plan, such as access to a specialist | Your plan, using its member materials, or the Medicare Complaint Form. |
| Unsafe conditions in a medical facility | Your State Survey Agency, usually part of the state health department. |
| Your health information privacy, or access to your records | The HHS Office for Civil Rights. |
We don't judge doctors, and we can't take complaints about care. If something on our site is wrong, use the corrections page or the report buttons on the doctor's page.
Getting Help
- Medicare.gov says you can file anonymously. How depends on the type of complaint.
- A SHIP counselor can help for free.
- A family member or friend can be appointed as your representative. See acting for a parent.
- 1-800-MEDICARE (1-800-633-4227) can give you your State Survey Agency's contact details. TTY users can call 1-877-486-2048.
Common Questions
Can I complain about a doctor's bill?
If a plan refused to pay, or you got a bill for a claim already submitted, that is an appeal. Ask 1-800-MEDICARE or your plan how to start one.
Will the doctor find out I complained?
Medicare.gov says you can file anonymously, though how depends on the complaint. Ask the group you are filing with.
Does reserve.doctor show complaints or board actions?
No. Check the state medical board. See how to check a doctor's license.