HOME ► Medicare Beneficiaries ► Medicare Mediation Program

Medicare Mediation Program

The Medicare Mediation Program is a new way for Medicare beneficiaries or their representatives to work out quality of care concerns with their doctor and/or healthcare provider (hospital staff, nursing home staff, health plan, etc.). The new program is voluntary and at no direct cost to you. This alternative to medical record review is an opportunity for you and your provider to tell your story, respond to each other, and resolve your concerns about the way you are treated.

Here are some answers to some basic questions you might have about mediation.

How will I know if my complaint is appropriate for mediation?
Not all complaints are appropriate for mediation. When you call HealthInsight to file a complaint, a review case manager will give you more details. If your complaint is suitable for mediation - which is determined by a HealthInsight Medical Director, the review case manager will explain the process in more detail.

What are the key features of a mediation session?
     - Participation is voluntary.
     - A professional mediator facilitates the session.
     - The session is usually conducted face-to-face but can also be conducted over the         telephone.
     - A session typically takes two to four hours.
     - The session is strictly confidential. The discussion is not documented and cannot be        used in legal proceedings.
     - You and your physician/provider determine the solution to your complaint.

Can I bring someone with me to the mediation?
Yes, if agreed to by the other party, you may bring a family member or designated representative to mediation. You may also be provided with a mediation advisor, a trained professional who can answer your questions about the mediation process.

How will mediation affect my relationship with my doctor or health care provider?
Participants often report improved relationships after the mediation session. If your doctor or provider agrees to participate, he/she is also committed to improving communication.

How does mediation affect my benefits under Medicare?
Participation is voluntary. Whether or not you choose to participate, your benefits under Medicare are not affected.

I am interested in the mediation option, what do I do?
Call HealthInsight at 1-800-748-6773. You will be directed to an individual who will be able to walk you through the process that follows. Keep in mind that not all complaints are suitable for mediation and you and your doctor or hospital representative must agree to participate in mediation before moving forward.