Identify Partner Advocates

HOW TO

For my patient who has received a denial

If your patient has been denied access to a behavioral health facility, you may be be wondering how to proceed. The following resources will help you identify partner advocates who can help advocate on behalf of your patient. The BD SUMHAC recommends these actions be taken as soon as possible to increase your patient’s chances of receiving care.

Tips for completing your Federal complaint

Start your complaint here.

Below is a list of the complaint questions and BD SUMHAC’s recommended answers.

Once you complete the screening questions, you will be able to submit the details of your complaint:

  1. Your first and last name

  2. Your phone number

  3. Your address

  4. Your email address

    1. Note: If you are filing the complaint on behalf of someone else, the first and last name of the person whose civil rights were violated (the person who received a denial to a mental health and/or substance use disorder treatment facility because of their BD)

  5. The reason that you have been (or someone else has been) discriminated against on the basis of: [select disability].

  6. Who or what agency or organization do you believe discriminated against you (or someone else)

    1. Person or Agency/Organization: [select agency/organization]

    2. Name of Agency/Organization

    3. Agency/Organization’s address

    4. Agency/Organization’s phone number (optional)

  7. When do you believe that the discrimination occurred?

    1. Insert specific dates (Please submit the date of the first denial and the length of time that you waited for placement or until discharge).

  8. Describe briefly what happened. How and why you believe that you(or someone else) have been  has been discriminated against. Please be as specific as possible. Be prepared to submit a succinct summary of the incident that describes the context, the specific reason(s) that they gave for denying access, etc.  Possible reasons include:

o   Bleeding disorders are too medically complex.

o   They can’t manage the infusions/injections.

o   They don’t allow needles in our facility.

o   An insurance issue related to BD medication.

o   An issue related to accessing medication at the specialty pharmacy.

Only 4,000 characters are allowed in the text box. However, they do allow you to upload additional files if you need to include more details.

9. Documentation of discrimination

10. Optional demographic information

11. How did you learn about the Office of Civil Rights: (please insert BD SUMHAC)

12. You will be asked to sign this form

13. And give your consent by signing this form