Quality of Care Concerns

What is a Care Concern?

A care concern is a complaint about the quality of your healthcare. It may also be about whether the treatment you got was appropriate. This is also known as a quality-of-care concern. Examples of care concerns may be:

• You got the wrong diagnosis.
• Your care was delayed.
• You got surgeries or procedures that failed or weren’t right for you.
• You were discharged from a hospital too early.
• You were given the wrong medication or not enough medication.
• Drug errors.

How We Handle Quality of Care Concerns

At Sunflower Health Plan, we take your care seriously. That’s why we have a Quality Program to review concerns about the care our members receive. This is called “peer review.”

What Is Peer Review?

Peer review means that qualified healthcare professionals, like doctors or nurses, review care concerns to make sure it meets high standards. When a member reports a concern, these experts carefully look at what happened and how we can improve.

Training Our Team

We train our staff to understand how peer reviews work and how to handle care concerns. This helps ensure we are always working to improve the care you receive.

We are committed to making sure you and all our members get the best care possible. If you have any questions, we’re here to help!

How to Report a Concern

We take all concerns into consideration. If you have a concern, you can report it, and we will review it thoroughly. To report a care concern, contact Customer Service toll free 1-877-644-4623 TTY: 711.

You can also file a grievance. You do not have to file a grievance for us to review your care concern.