MichUHCAN's Patient Issue Report Form

Click here to see the form, or read below first.

Advice on usage:

You deserve the best from your doctor, from your clinic or hospital, and from your health care insurance coverage. Unfortunately, the cost-cutting reflex of a profit-seeking insurance company or hospital sometimes sacrifices your care in favor of their bottom line. Questionable quality of care, denial of coverage for useful procedures and medications, no approved access to needed specialists, and even unreasonable waits for appointments are some of the ways in which cost-cutting can make the care you get less than the care you deserve.

You can make your voice heard if you take the time to make a formal complaint about this sort of poor treatment. Complaints should be made to at least three places: the health care institution, the insurance company, and the State Insurance Bureau. In addition, you may want to notify your employer, if your employer is paying for the insurance, or your union, if your insurance coverage is the product of collective bargaining. If for any reason you have cause to file a lawsuit against the institution or the insurance company, it may be helpful to your case to have documents showing that you objected to your treatment at the time it occurred.

If enough patients protest enough times, some problem areas in health care can be identified and they can be improved. To encourage this sort of action, MichUHCAN (Michigan Universal Health Care Access Network) is making a "Patient Issue Report Form" available. Anybody may reproduce and use this form without charge. When you use this form, if you could also send a copy to:

MichUHCAN, 8846 Robindale, Detroit, MI 48239

we would appreciate it, but this action is not at all required. Your name will not be used without your permission, not even added to our mailing list.

Examples of quality care complaints are:

Clinic visits

Appointment time too short to address health concerns
Unreasonably long waits to be seen for visits and exams
Insurance will not pay for medicines prescribed by doctor
Pharmacist substitutes less effective medicine for that actually prescribed
Your access to specialists in your condition is denied or long delayed

Problems with bureaucracy

Unqualified clerical personnel evaluating severity of your symptoms over the phone, perhaps even giving medical advice on this basis
Unreasonable wait to receive a return call from physician or nurse
Unreasonable wait for or denial of diagnostic tests desired by physician

Hospital care

Inadequate staffing causing long response times
Family member too sick for hospital area (perhaps transferred out of critical care or intensive care unit while still needing close attention)
Patient discharged while still needing medical attention
Long wait in Emergency Room while waiting to be admitted to hospital
Failure to get medication or treatment as called for by physician