Pre-Notificaiton Letter

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Phone: 516-209-5253
Fax: 516-326-7805
[email protected]
www.esrdncc.org

ESRD NETWORK
COORDINATING CENTER (NCC)
1979 Marcus Avenue, Suite #105
Lake Success, NY 11042-1072
www.fistulafirst.org

www.kcercoalition.org.

Date

Dear [Mr./Ms./Dr. Name of Grievant]
I work for the End Stage Renal Disease (ESRD) Network Coordinating Center (NCC). We
work with Medicare to make sure patients are happy with the way their ESRD Network
handles their grievance. Please know that we are not connected in any way to the ESRD
Network or your dialysis center.
We are calling patients who have filed a grievance to take part in a survey. We will use
what we learn from this survey to help Medicare support Networks and improve the way
they handle the grievance process.
Our records show you filed a grievance with [Network Name] on or around [Complete
Date]. If this is true, we would like to ask you some questions about your contact with
[Name of Network].
A surveyor from [name of survey vendor] will be calling you soon. Anything you tell the
surveyor is private; we will not share your answers with the [Network Name] or your
dialysis center. Your answers will not change your Medicare benefits or the care you
receive. You can also decide whether you want to talk when the surveyor calls you.
If you did not file a grievance, please tell the surveyor during the call. We will try to call you
five times to set up your interview. We will choose a time that is good for you.
One of our surveyors will call you on the following dates:


mm/dd/yyyy and mm/dd/yyyy [between 9:00 am and 7:00 pm]; and



mm/dd/yyyy and mm/dd/yyyy [between 9:00 am and 7:00 pm]

If you do not have time to talk when the surveyor calls, you can choose a better time for
your interview.
The surveyor will ask different types of questions during the call. Each call should last 15
minutes.
The questions will be about your contact with [Network Name] during the time you filed
your grievance. They will not be about what happened with your grievance. We will keep

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ESRD NETWORK
COORDINATING CENTER (NCC)
1979 Marcus Avenue, Suite #105
Lake Success, NY 11042-1072
www.fistulafirst.org

Phone: 516-209-5253
Fax: 516-326-7805
[email protected]
www.esrdncc.org

www.kcercoalition.org.

your answers private. Your dialysis facility or [ESRD Network] will not see your answers.
Your answers will not change your Medicare benefits.
Your feedback is very important to us. But if you choose not to take this survey, there will
be no change in the care and services you receive.
If you have any questions or would like a paper copy of the survey to follow during your
phone call, please contact:
Renee Dupee
Medicare
410-786-6747
Email [email protected].
Thank you for your time.
Sincerely,

End Stage Renal Disease Network Coordinating Center