What is a complaint (grievance)? What to do if you have a problem?
The complaint process is used for certain types of problems only, such as problems related to quality of care, waiting times, and customer service. Here are examples of the kinds of problems handled by the complaint process.
- You are unsatisfied with the quality of your care, such as the care you got in the hospital.
- You think you are being pushed out of the plan.
- You have been kept waiting too long by doctors, pharmacists, or other health professionals or by Member Services or other plan staff.
- A health care provider or staff was rude or disrespectful to you.
- You think the clinic, hospital or doctor’s office is not clean.
Who can file a complaint (grievance)?
You may file a complaint. Or, someone else may file the complaint for you with your permission.
Appointing a representative
You can name another person to act for you as your "representative" to ask for a complaint.
If you want a friend, relative, or other person to be your representative, call Member Services and ask for the "Appointment of Representative" form. You can also get the form on the Medicare website by clicking the link below. The form will give the person permission to act for you. You must give us a copy of the signed form with your request.
When can a complaint (grievance) be filed?
Complaints related to Medicare Part D must be made within 60 calendar days after you had the problem you want to complain about. There is no filing limit for complaints related to Medicare Part C or about quality of care.
When will the health plan respond?
If we cannot resolve your complaint within the next business day, we will send you a letter within 5 calendar days of receiving your complaint letting you know that we received it.
If you are making a complaint because we denied your request for a "fast coverage decision" or a "fast appeal," we will automatically give you a "fast complaint" and respond to your complaint within 24 hours. If you have an urgent problem that involves an immediate and serious risk to your health, you can request a "fast complaint" and we will respond within 72 hours.
If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer on the same phone call. If your health condition requires us to answer quickly, we will do that.
Most complaints are answered in 30 calendar days. If we need more information and do not come to a decision within 30 days, we will notify you in writing and provide a status update and estimated time for you to get the answer.
Where can a complaint (grievance) be filed?
File complaints in writing to:
Complaints, Appeals & Grievances
12900 Park Plaza Drive
Cerritos, CA 90703
To file a complaint over the phone, or for process and status questions, please call Member Services at 1-888-350-3447 (TTY: 711), Monday - Friday 8 a.m. to 8 p.m. PST to:
- File a complaint over the phone
- Get a status on a filed complaint
- Learn more about our complaint process