BD SUMHAC recommends making a complaint to the ombudsman’s office as soon as possible after the denial so that the ombudsman can help the facility ensure that the facility’s admissions decisions are consistent with state regulations. 

All states have an office of the ombudsman for behavioral health or its equivalent (it may also be called the state office of the inspector general). These offices are independent governmental offices that receive complaints against government and government-regulated agencies. They investigate and take action to remedy the complaints. They provide assistance in the following areas: 

• Concerns or complaints about services

• Questions about rights

• Grievances

• Access to appropriate services

• Ideas for making services better

The ombudsman offices regularly work with behavioral health programs. They are typically known partners, and outreach from the ombudsman’s office is generally taken very seriously by local facilities/programs. 

Who can file a complaint?

A person who has been denied access, their family, or a member of their bleeding disorder treatment team may contact the office of the ombudsman to make a verbal complaint.  Most state ombudsman offices also provide the option to make an electronic complaint. 

Hello, my name is [Your Name], and I’m reaching out because I was recently denied admission to an inpatient or residential mental health and/or substance use treatment facility. I’m requesting your assistance in reviewing this denial and helping me understand whether it complies with patient access and nondiscrimination requirements.

[Briefly list or quote the reason(s) provided, such as: medical needs, prescribed medication, perceived medical complexity, staffing limitations, policy restrictions, or other explanations given.]

I’m seeking your support because I don’t feel equipped to navigate this process alone, and the denial has been very stressful and discouraging.

My medical condition is stable and managed by my healthcare provider. I’m concerned that this denial may create a barrier where individuals are forced to choose between necessary medical treatment and access to mental health or substance use care.

I respectfully request your assistance to:

• Review the circumstances of this denial

• Determine whether it aligns with applicable patient protections or access requirements

• Help facilitate communication with the facility, or

• Provide guidance on appeal, reconsideration, or next steps

I appreciate any guidance or advocacy you can provide. I am happy to share documentation from my referring provider or any written denial materials if helpful.

Thank you for your time and for the important role you play in supporting patient access to care.

Denial Details

(Providing these details up front may help expedite review)

• Name of facility:
  [Facility Name]

• Facility address:
  [Street, City, State, ZIP]

• Facility phone number:
  [Phone Number]

• Facility contact person (if known):
  [Name, title, email/phone]

• Date of denial:
  [MM/DD/YYYY]

• Type of denial:
  ☐ Written
  ☐ Verbal
  ☐ Both

• How the denial was communicated:
  ☐ Phone call
  ☐ Email
  ☐ Letter
  ☐ Patient portal
  ☐ Other: [Specify]