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If you wish to file a grievance, complete and submit this online
form.
The
California Department of Managed Health Care is responsible for
regulating health care service plans. If you have a grievance
against your health plan, you should first telephone your health
plan at 1-800-707-6453 and use your health plan's grievance
process before contacting the department. Utilizing this grievance
procedure does not prohibit any potential legal rights or remedies
that may be available to you. If you need help with a grievance
involving an emergency, a grievance that has not been satisfactorily
resolved by your health plan, or a grievance that has remained
unresolved for more than 30 days, you may call the department for
assistance. You may also be eligible for an Independent Medical
Review (IMR). If you are eligible for IMR, the IMR process will
provide an impartial review of medical decisions made by health
plan related to the medical necessity
of a proposed service or treatment. Coverage decisions for
treatments those are experimental or investigational in nature and
payment disputes for emergency or urgent medical services. The
department also has toll-free telephone number (1-888-HMO-2219) and
a TDD line (1-877-688-9891) for the hearing and speech impaired. The
departments Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application
forms and instructions online.
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