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Home Healthcareplans Cal MediConnect Complaints, Grievances & Appeals

Complaints, Grievances & Appeals

Complaints, Grievances & Appeals

Quality of Service or Care

If you have a complaint regarding the quality of service or care you got, please let us know right away. The formal name for “making a complaint” is “filing a grievance.” Here are some examples of the kinds of problems handled by the complaint process:

  • You are unhappy with the quality of care, such as the care you got in the hospital.
  • You think that someone did not respect your right to privacy, or shared information about you that is confidential.
  • A health care provider or staff was rude or disrespectful to you.
  • SCFHP staff treated you poorly.
  • You think you are being pushed out of the plan.
  • You cannot physically access the health care services and facilities in a doctor or provider’s office.
  • Your provider does not give you a reasonable accommodation you need such as an American Sign Language interpreter.
  • You are having trouble getting an appointment, or waiting too long to get it.
  • You have been kept waiting too long by doctors, pharmacists, or other health professionals or by Customer Service or other plan staff.
  • You think the clinic, hospital or doctor’s office is not clean.
  • Your doctor or provider does not provide you with an interpreter during your appointment.
  • You think we failed to give you a notice or letter that you should have received.
  • You think the written information we sent you is too difficult to understand.
  • You believe that we are not meeting our deadlines for making a coverage decision or answering your appeal.
  • You believe that, after getting a coverage or appeal decision in your favor, we are not meeting the deadlines for approving or giving you the service or paying you back for certain medical services.
  • You believe we did not forward your case to the Independent Review Entity (IRE) on time.

If you need help, please call Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. You can also get help or information from the Cal MediConnect Ombuds Program by calling 1-855-501-3077 or by visiting their website at www.healthconsumer.org.

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