| Message
from the California Department of Managed Health Care:
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
contact Santa Clara Family Health Plan at 1
(800) 260-2055 and use Santa Clara Family
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 Santa Clara
Family Health Plan, or a grievance that has remained
unresolved for more than 30 calendar 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 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-HMO-2219)
for complaints and a TDD line 1 (877-688-9891) for the hearing and speech impaired. The department’s
Internet website
http://www.hmohelp.ca.gov has
complaints, IMR application forms and instructions
online. |
