Alternative Dispute Resolution

TMF Health Quality Institute offers Alternative Dispute Resolution (ADR) as an option to resolve Medicare beneficiary complaints about the medical care they receive under the Medicare program. If the complaint does not involve quality of care issues, voluntary and confidential ADR services may be offered. When you call TMF to file a complaint, a review case manager will give you more details. If your complaint is suited for ADR, the process will be further explained to you.

The three ADR options include mediation, facilitated resolution, and external resolution

• Mediation is a dialogue between you and your doctor or hospital, facilitated by an impartial third person (the mediator). It is an opportunity for you and your doctor or hospital to tell your story, respond to each other, and resolve your concerns about the way you were treated.
• Facilitated resolution is an option where animpartial third person, a facilitator, will speak to you and the doctor or hospital, in separate, independent telephone discussions. The facilitator conveys information from you to the provider describing your concerns and what you say could have happened to prevent the complaint. 
• External resolution or “self resolution” occurs when, in the course of pursuing one or both of the ADR options, the doctor or hospital initiates contact with you or you contact the doctor or hospital, to discuss what might be done to resolve the complaint.

Use the brochure below for information regarding resolving your health care concerns.

Guide to Resolving Your Health Care Concerns

English (152kb PDF) / Español (152kb PDF)

For more information on Medicare, please call the Medicare Helpline at 1-800 MEDICARE (1-800-633-4227).