We are committed to ensuring our members receive high-quality care and service. If you are dissatisfied with your care, services, or a coverage decision, you have the right to file a grievance or appeal through your health plan.
Quality of Care Complaints (Grievances)
If you’re unhappy with the quality of care or services—not related to a denied treatment—you or someone you authorize may file a grievance with your health plan. This process allows you to report issues such as:
- Long wait times
- Difficulty accessing specialists
- Communication or cultural sensitivity concerns
- Facility or staff-related problems
Please refer to your health plan’s member materials for instructions on how to submit a grievance.
Appealing a Denied Services
If your health plan denies a service and you disagree with the decision, you have the right to appeal. Appeals must be submitted within 60 days of the denial. You can file:
- A Standard Appeal, which is reviewed within 30 working days
- An Expedited Appeal, processed within 72 hours if waiting could seriously harm your health
Appeals can be submitted verbally or in writing. Be sure to include your denial notice and a brief explanation.
Expedited Appeals
If your health is at serious risk due to a delay, you may request an expedited appeal. Your health plan will evaluate your condition and respond within 72 hours. If the decision is not in your favor, you may request a hearing with the Appeals and Grievance Committee, which will be scheduled within 10 working days.
Below are the processes and contact details for each contracted health plan:
Anthem Blue Cross
- Grievance/Appeal Deadline: Within 180 calendar days of the incident or denial.
- How to File:
- Phone: 1-800-365-0609 (TTY: 711)
- Mail: Grievances and Appeals, P.O. Box 4310, Woodland Hills, CA 91365-4310
- Online: Anthem Grievance Form
- Expedited Review: Available for urgent medical issues.
Blue Shield of California
- Grievances/Appeal Deadline: Within 180 days of the issue.
- How to File:
- Phone: 1-800-393-6130 (TTY: 711)
- Mail: Blue Shield of California, Attn: Member Services Grievances, P.O. Box 5588, El Dorado Hills, CA 95762-0011
- Online: Blue Shield Grievance Form
- Expedited Review: Available for serious health threats.
Humana
- Grievance/Appeal Deadline: Within 65 calendar days of the denial or issue.
- How to File:
- Phone: 1-800-867-6601 (TTY: 711)
- Mail: Humana Grievances and Appeals, P.O. Box 14165, Lexington, KY 40512-4165
- Fax: 1-800-949-2961 (medical services) | 1-877-556-7005 (medications)
- Online: Humana Grievance & Appeal Form
- Expedited Review: Available when delay may jeopardize health or function.
SCAN Health Plan
- Grievance/Appeal Deadline: As outlined in your Evidence of Coverage.
- How to File:
- Phone: 1-800-559-3500 (TTY: 711)
- Mail: SCAN Health Plan, Grievance and Appeals Department, P.O. Box 22644, Long Beach, CA 90801-5644
- Online: File a Grievance | File an Appeal
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Expedited Review: Available for urgent medical needs.
Need Help?
If you need assistance filing a grievance or appeal, please contact your health plan directly or reach out to our Member Services team. We’re here to support you through the process.
You may also get help from the California Department of Managed Health Care (DMHC), if your grievance:
- Involves an emergency
- Has not been resolved by your health plan
- Has remained unresolved for more than 60 days
You may contact the DMHC Help Center at:
The DMHC oversees health plans in California and ensures your rights are protected.