6 ·
My Health
If you have a problem or complaint about the
care you get from a provider in your plan, you
can file a complaint by phone or in writing within
180 days of when the problem started. You can file
your complaint through us, through L.A. Care or
through your doctor’s office.
We can help you with your problem
Just call the Customer Care Center to speak with
someone who can help you. The phone number is
on the back page of this newsletter. Most problems
can be solved quickly. If not, someone will help
you file a complaint by phone.
If you would rather talk to someone in a language
other than English, please call the Customer Care
Center and ask. We will get someone who speaks
your language. That person can help translate your
complaint as well.
You can also file your complaint in writing. Call
the Customer Care Center, and we will mail you
a form.
What to do if you
have a complaint
What to do if you get a Notice of Action
A Notice of Action is a formal letter you get from us. It tells you that a medical
service has been denied, delayed or changed. If you get a Notice of Action from us
and are not happy with it, you have three options:
1
You can file an appeal with us if you disagree with what is in the letter. You can
also request a State Fair Hearing at the same time. But you must file the appeal
within 90 days from the date on the Notice of Action.
2
You also may request a State Fair Hearing from the Department of Social Services
if you disagree with what is in the Notice of Action. But you must request the
State Fair Hearing within 90 days of the date of the letter. A State Fair Hearing
allows you to take your case to the state even if you filed a complaint, grievance
or appeal with us and your issue was solved. To ask for a State Fair Hearing, call
1-800-952-5253
. Your doctor also can ask for a State Fair Hearing for you.
3
You may ask for an Independent Medical Review (IMR) from the Department
of Managed Health Care if you disagree with what is in the Notice of Action.
But you can’t request an IMR if you have already requested a State Fair Hearing
for the same issue. You can request an IMR up to six months from the date you
get a Notice of Action from us. Materials on how to file an IMR will come with
your Notice of Action.
After you fill out the form, mail it to:
Attn: Grievance Coordinator
Anthem Blue Cross
Partnership Plan
PO Box 9054
Oxnard, CA 93031-9054
Or write to:
L.A. Health Plan
Member Services Department
555 West Fifth St.
Los Angeles, CA 90013
After you mail or call with a complaint, we will
send you a letter:
•
Within five days of getting your form to
let you know we are looking into your
complaint (grievance).
•
Within 30 days of getting your form to
let you know how we resolved the problem.
If your case has to do with a serious or immediate
threat to your health, we will respond within three
days of getting your form.
To learn more about how to file a complaint, check
your Member Handbook.
Speak another
language? ¿Habla
otro idioma?
Let us interpret
We can help you no matter what your
preferred language is. We have a
free interpretation service. Just call
us at
1-888-285-7801
during office
hours. Ask for translation services in
the language you prefer. You also can
call the 24/7 NurseLine after hours
at
1-800-224-0336
.
You can ask for written materials about
your benefits to be read to you over the
phone in your language. Or you can get
them in writing in that language. Just
call the number above. If you have hearing or
speech loss, you can call the TTY line at
1-888-757-6034
.
Podemos traducir esto gratuitamente. Llame al número de servicio de
atención al cliente que aparece en su tarjeta de identificación (ID card).
