Have a Complaint? Let Us Know. We’re Here to Help.
Community Care Health (CCH) wants you to have the best care and service possible. We want to hear from you when you are happy with your health care services, and if you need assistance. We are here to help you resolve any problems you may have. If there is a problem with the delivery of your healthcare, talking with your Primary Care Physician or other Specialty providers may be the best way to get the issue resolved quickly. If you have not been able to get your concern resolved, please call our Customer Service Team at (855) 343-2247, Monday through Friday between the hours of 8 a.m. and 5 p.m. Our staff will work with you to resolve the problem. You also have the option to file a grievance, which is defined as any written or oral expression of dissatisfaction regarding the plan and/or provider, including quality of care concerns. A grievance shall include a complaint, dispute, request for reconsideration, or appeal made by a member or the member’s provider.
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
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 (insert health plan’s telephone number) 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 telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.
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.