File a Grievance

For the safety of our members and employees, and to follow public health guidelines, the Alliance will no longer host in-person meetings at our offices during the COVID-19 pandemic. However, the Alliance is committed to serving your needs during this time.

If you are not happy with a provider or the provider’s office, it is best to talk to them first. Let someone in the office know what happened as soon as possible. Ask him or her for help with fixing the problem. The Alliance is here to help you, so please call us for assistance.

If you are not happy with your experience in a hospital or other facility, you can ask to speak with a nurse, social worker or patient advocate. Then, call the Alliance so that we can help you.

If you are getting a bill for services that are covered by the Alliance, call the number of the billing department on the statement. Let them know you have the Alliance as your insurance and ask them to send a claim to us directly. Then, call us right away. Tell us the amount charged, the date of service and the reason for the bill so we can help you.

There is no time limit to file a complaint, but we do encourage you to file close to the date of your concern. If the Alliance denied you a requested service and you disagree with this decision you can file an appeal. An appeal has a time limit and must be filed within 60 days from the date of a decision.

There are many ways to file a grievance or appeal:

• By phone: Call Member Services. Give us your Alliance ID number, your name and the reason for your complaint.
• By mail: Call Member Services and ask to have a form sent to you. You can also get a grievance form from your doctor’s office. Include your name, Alliance ID number and the reason for your complaint on the form.
  Mail the form to:
  Grievance Unit
  1600 Green Hills Road, Suite 101
  Scotts Valley, CA 95066

• Online: Fill out an online Grievance Form.
• In-person: Visit our office to speak face-to-face with a representative about your grievance.
• Doctor’s office: You may file a grievance directly through your doctor’s office.

You can ask for an expedited, or fast review, if you feel that the Alliance denied you a requested service that can be an urgent or serious threat to your health. This can include, but is not limited to, severe pain, loss of life, limb or major bodily function. If your grievance qualifies, we will resolve it within 72 hours of receipt.

Within 5 days of getting your complaint, we will send you a letter to let you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. To ask about the status of an existing grievance, please call to speak to a Grievance staff member. If you are still unhappy after we try to resolve your case, we will tell you what steps you can take next.

If you feel the Alliance or a health care provider has not respected your privacy, you have the right to file a complaint with the Department of Health and Human Services at any time by contacting:

Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC, 20201

The State Office of the Ombudsman will help Medi-Cal members who are having problems with their health plan. You can call them toll free at 888-452-8609.

You may also contact the California Department of Managed Health Care.