Quality of care concerns
A quality of care concern is any alleged or actual event or incident that creates a substantial risk or severe harm to the physical, mental, or emotional well-being of a Healthy Blue member.
Reportable concerns
Report any quality of care concern that affects, or could affect, a Healthy Blue member while they are receiving healthcare services. A concern can include, but is not limited to:
Abuse: The injury, confinement, control, intimidation, or punishment of an individual that has resulted in physical harm, pain, fear, or mental anguish. Abuse includes but is not limited to physical, emotional, verbal, or sexual abuse, or the use of restraint, seclusion, or the use of restrictive interventions.
Neglect: When there is a duty to do so, failing to provide an individual with any treatment, care, goods, or services necessary to maintain the health or welfare of the individual.
Exploitation: The unlawful or improper act of using an individual or an individual's resources through means of manipulation, intimidation, threats, deceptions, or coercion for monetary or personal benefit, profit, or gain.
Misappropriation: The act of depriving, defrauding, or otherwise obtaining the money, real or personal property (including prescribed medication) of an individual by any means prohibited by law that could potentially impact the health and welfare of the individual.
Unnatural or accidental death: Death that could not have reasonably been expected, or the cause of death is not related to any known medical condition of the individual, including inadequate oversight of prescribed medication or misuse of prescribed medication.
Report a quality of care concern or incident
If you feel a member is at significant risk or has shown signs of mistreatment, please fill out our Quality of Care Referral form.