What is facilitated resolution?
It is a form of conflict resolution in which you tell a “facilitator,” (who is a go-between or intermediary between you and your healthcare provider), what concerns you about the health care you received from your doctor or provider. The facilitator will then call the provider and, with your permission, give him/her the information you provided. The provider is asked to respond to what you have said about the situation.
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How will I know if my complaint is appropriate for facilitated resolution?
Not all complaints are appropriate. During the medical record review process, Primaris determines if the case is appropriate and will then ask you if you would like to participate.
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What happens in facilitated resolution?
- You tell the facilitator what happened to you and what would have prevented you from making the complaint.
- The facilitator calls the provider and tells him/her what you said.
- The provider has an opportunity to say what might be done to prevent a similar situation from happening in the future.
- The conversations are confidential and the information cannot be used in any legal proceedings. You will be provided with a summary of any resolution suggested by the provider.
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Will I be able to tell the provider that he/she made a mistake?
You can say what happened to a facilitator who will then telephone the provider. In this process, you don’t tell them directly but through the facilitator.
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How will this process affect my relationship with my doctor, hospital or healthcare plan?
There is a good possibility that relationships can be improved with this process. If your provider agrees to participate, it is typically a sign that he/she is committed to improving communication.
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Does facilitated resolution affect my benefits under Medicare?
No, your benefits are not affected if you choose to participate.
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If I decide to participate in facilitated resolution, what should I do?
If you're in Missouri, call Primaris toll-free at 1-800-347-1016. We will walk you through the process. Keep in mind that all concerns are not suitable for facilitated resolution. Your doctor/provider and you must both agree to participate in facilitated resolution before moving forward.
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Facilitated Review - Frequently Asked Questions
