File a Grievance
We want you to be happy with your health care and our service. If you are not happy, you can tell us by filing a complaint, also called a grievance. We can help you solve problems you may have with a doctor, with the Alliance or with getting medical equipment that you need.
You have the right to file a grievance about things like:
- Having to wait a long time to be seen by a doctor or to get an appointment.
- The type of care you received from your doctor or how you were treated in the office.
- Being charged or asked to pay for services you think should have been covered by the Alliance.
- A decision we have made to change or deny services.
Our staff can help you to file a complaint (grievance) or an appeal. An appeal is a disagreement with an Alliance decision. Translation assistance is available when you file a complaint or appeal. You can also have a family member or friend help you file your complaint. We want to protect your rights. Expressing concerns or filing a complaint will not affect your benefits. Your provider also cannot discriminate against you because you filed a complaint.
California Department of Managed Health Care Statement
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 (800) 700-3874 or TDD (877) 548-0857 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.
Grievance Unit Contact
Toll free: 800-700-3874
Monday-Friday, 8 a.m. to 5 p.m.