Start your complaint here.

Below are the screening questions and BD SUMHAC’s recommended answers.

1. Question 1 - What is the nature of your complaint? 

• Violation of Civil Rights (Based on Race, Color, National Origin, Disability, Age, or Sex) (Select this because a denial based on a BD is discrimination based on disability.)

• Violation of Conscience or Religious Freedom

• Violation of Privacy or Security of Health Information (HIPAA)

2. Question 2 - When did the most recent discrimination or violation occur? The options include:

• The most recent incident was within the last six months 

1. Select this if you were eventually able to gain access to a facility or you were discharged and you are no longer seeking inpatient/residential behavioral health treatment.

• The most recent incident was over six months ago

1. Select this if you were eventually able to gain access to a facility or you were discharged and you are no longer seeking inpatient/residential behavioral health treatment. If you select this answer, you will get a response that states, “Please note that under our regulations, OCR normally can accept only complaints that are filed within 180 days of when a complainant knew or should have known that the alleged violation occurred. Based on the information provided, this complaint is untimely. If you would like to file this complaint anyway, please include an explanation for why you waited over six months to file. Please note that you must have a very good reason for waiting so long to file in order to get the time period waived.” Although complaints may be untimely, the Office of Civil Rights has encouraged the BD community to submit them anyway as they are trying to better understand the pattern of discrimination that has been facing the BD community for years.

• It is ongoing 

1. Select this if you are still seeking inpatient/residential behavioral health treatment.

3. Question 3 - Do you think your employer or prospective employer is discriminating against you? 

• Yes

• No (Select “no” if the primary concern is the mental health and/or substance use disorder treatment facility’s decision to deny you access based on your BD)

4. Question 4 - Do you believe a health insurance company, health insurance plan, issuer, sponsor, or administrator, or health benefits program discriminated against you or violated your civil rights, conscience, or religious freedom? 

• Yes

• No (Select “no” if the primary concern is the facility’s decision to deny you access based on your BD)

5. Question 5 - Do you think a school or education program is discriminating against you? 

• Yes

• No (Select “no” if the primary concern is the  facility’s decision to deny you access based on your BD)

6. Question 6 - Are you having problems receiving foods stamps (SNAP) or WIC? 

• Yes

• No (Select “no” if the primary concern is the facility’s decision to deny you access based on your BD)

7. Question 7 - Does your issue concern problems with Section 8 housing or discrimination under the Fair Housing Act? 

• Yes

• No (Select “no” if the primary concern is the facility’s decision to deny you access based on your BD)

8. Question 8 - Are you having issues with conditions or discrimination in a prison, jail, or other correctional facility? 

• Yes

• No (Select “no” if the primary concern is the facility’s decision to deny you access based on your BD)

9. Question 9 - Is this regarding Social Security? 

• Yes

• No (Select “no” if the primary concern is the  facility’s decision to deny you access based on your BD)

10. Question 10 - Do you believe that any other healthcare provider, such as any of the ones listed below, discriminated against you or violated your civil rights, conscience, or religious freedom: • State or local government agency that is responsible for administering health care • State or local government income assistance or human service agency • Hospital • Medicaid and Medicare provider • Physician or other health care professional in private practice with patients assisted by Medicaid • Family health center • Community mental health center • Alcohol and drug treatment center • Nursing home • Foster care home • Public and private adoption or foster care agency • Day care center • Senior citizen center • Nutrition program • Any entity established under the Affordable Care Act • HMO • Pharmacy • Homeless shelter •Health researcher

• Yes (Select “yes”) 

• No