申訴和上訴

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 telephone your health plan at 1-209-942-6320 and use your 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 your health 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 (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s Internet website http://www.dmhc.ca.gov在線提供投訴表、IMR 申請表和說明。

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 Department of Social Services toll-free at 1-800-952-5253 to request a State Fair Hearing. This type of hearing is an administrative proceeding where you can file your complaint directly with the State of California. If you decide to request a fair hearing, you may represent yourself at the hearing or someone else, such as a lawyer, friend, family member, or anyone you choose may represent you. The Department of Social Services can help you get a public defender, free of charge, to help you with your State Fair Hearing.