What to do if you have a problem or complaint

If you have a problem with the plan or with your services or payment there are processes available to help you communicate with the plan. These processes have been approved by Medicare and Medi-Cal. Each process has a set of rules, procedures and deadlines that must be followed by the plan and by you.

There are difficult legal terms for some of the rules and deadlines. Many of these terms can be hard to understand, so we have used simpler words in place of the legal terms. Knowing the proper legal terms may help you communicate more clearly, so we provide those too.

Select one of the links below for more information on:

• Coverage Decisions
• Complaints (Grievances)
• Appeals

For more information about how to ask for coverage determinations and submit complaints and appeals, see Chapter 9 in your Member Handbook.

To find out how many appeals, grievances and exceptions have been filed with our plan over the past year or to get the status of your request, please call Member Services at 1‑888‑350‑3447 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. The call is free.