Message from the California Department of Managed Health Care (DMHC)
The DMHC is responsible for regulating health care service plans. If you have a
Grievance against HPSJ, you should first telephone the plan at (209) 942-6320, or
outside Stockton, toll-free at 1-800-932-PLAN (7526) and use HPSJ’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 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-HMO-2219) 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 complaint forms, IMR application forms and instructions online.
A Message from the Department of Health Services (DHS)
Medi-Cal members have the right to request a State Fair Hearing at any
time during the grievance and appeal process. You may call the State
Department of Social Services toll free number at 1-800-952-5253 to request
a State Fair Hearing. This type of hearing is an administrative procedure
at which you can present your concern directly to the State of California.
If you decide to request a State Fair Hearing you may represent yourself at
the hearing or another person, such as an attorney, friend, relative or any
person you choose may represent you. The Department of Social Services can
help you obtain a Legal Aid lawyer, free of charge, to help you with your
State Fair Hearing.
