HEALTH RIGHTS HOTLINE Independent Assistance For Health Care Consumers

Health Rights Hotline Sample Letter

Cover Letter to State Licensing Board

State boards license and oversee doctors, psychologists, chiropractors, pharmacists, and other health care professionals. The licensing boards will often take complaints about, and investigate, the professionals they oversee. You do not have to file a grievance or appeal with your health plan to report a problem to a state licensing board; however, by filing a grievance you make your medical group or health plan aware of the problem. Following is a sample letter to a state licensing board. This letter suggests a basic format for reporting a problem to a state licensing board. Be sure to add your own facts to this letter.

Here are some tips for using this letter:

• Use only the parts of the letter that are appropriate based on your facts. This letter is meant as a guide and it may contain language that does not apply to your situation.
• Places where you can insert your information are identified by brackets (“[ ]”), and the description of the information to add is underlined. Delete the brackets and the sample description and fill in your own information.
• The letter includes advice to you that is in parenthesis (“{ }”), with the text of the advice in italics. You should delete these sections from your letter.
• The sample letter is addressed to the Medical Board of California. You may want to call the board at (916) 263-2382 to find out if there is a specific department or person who receives complaints against, or requests for investigation of, licensed professionals.

Some telephone numbers of other California licensing boards are:

If your concerns a hospital, clinic, or nursing home, you can also call Department of Health Services Licensing and Certification at (916) 440-7510.

• Attachments - You should attach to your letter copies of any information that helps explain the problem you have experienced. At the end of the letter are examples of the sort of attachments you might want to include. In some cases, a letter may have no attachments; in other cases, there may be many.
• Sending Copies - Consider sending copies of your letter to others who may be helpful in resolving your problem. Please see the end of the letter for suggestions of other agencies to which you might want to send copies.

Health Rights Hotline
Sample Cover Letter to State Licensing Board
(see tips for using this letter)

[date]

Medical Board of California
1426 Howe Ave. #54
Sacramento, CA 95825

Dear Medical Board:

I am writing to report a problem with [name of professional], a licensed [name of profession].

I am unhappy with the services provided by [name of provider] for the following reasons: {describe the problem experienced, how it impacted your health, and why you feel the problem should not have occurred or what should have been done differently; include any relevant date(s) and any names of people involved, and any actions you have already undertaken attempting to resolve the problem}.

I have filed a complaint with my health plan. A copy of my [appeal OR grievance] is enclosed.] I would appreciate it if you would investigate this matter and take appropriate action to prevent the problem from happening again. You may contact me at [telephone number] if you would like any additional information. Please notify me in writing of the results of your investigation.

Thank you, in advance, for your attention to this matter.

Sincerely,

[your name] 

cc: {Possible individuals and/or groups to whom you can consider sending copies of your letter:}

[Health Plan Medical Director][Medical Group Medical Director]
[Your doctor or provider]<
[Party you are complaining about]
[Your employer or insurance broker]
[State regulatory agency]

Enclosure(s): {list and attach any written documentation that supports your complaint}

Copy of [grievance or appeal], including attachments (medical records, letters from doctors, etc.).