Have a complaint? Let us know. We’re here to help.
How to File a Complaint
A member has 180 calendar days from the date of an incident or dispute, or from the initial payment or denial notice to begin the grievance process. There are several ways to file a grievance. You can complete the form available on this website and submit it online. You may also write a letter or send a completed grievance form to the Grievance and Appeal Department at:
Grievances and Appeals CCH
PO Box 45020
Fresno, CA 93718
Get Grievance Forms
About the Grievance Process
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 1-855-343-2247 or at the TDD line 1-800-735-2929, 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 a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free number (888-HMO-2219) and a TDD line (877-688-9891) for the hearing and speech impaired. The department’s Internet website has complaint forms, IMR application forms and instructions online. You may also contact the department by writing to the following address: 980 9th Street, Suite 500, Sacramento, CA 95814 or by e-mail at email@example.com.
How We'll Respond
We will send you a letter to let you know that we received your grievance within five days and a decision letter within 30 days. If your grievance involves an imminent and serious threat to your health, including, but not limited to, severe pain, potential loss of life, limb or major bodily function, we will provide you with a decision within 72 hours.
If you have any questions or need immediate assistance, please contact our customer service toll-free at 1-855-343-2247. We’re available to assist you from 8 a.m. to 5 p.m., Monday to Friday.