Rights

What if:

• I am not happy with my doctor or dentist?
• I disagree with my doctor or dentist about what is best for my family or me?
• My doctor or dentist denies or delays my request to see a specialist, have more visits, or get certain medicines?
• My doctor or dentist or medical or dental plan denies or limits medical or dental services?
• My medical or dental plan reduces or stops a service I was getting before I changed plans?
• I got a “Notice of Action” that denied, delayed, modified or reduced my treatment request, or ended treatment I was getting?

You have a right to do any or all of these:

Change your medical or dental plan

• Call Health Care Options to ask for an information packet at 1-800-430-4263 (TTY 1-800-430-7077).
• Complete the choice form and follow the mailing instructions on the form.

File a complaint or grievance with your medical or dental plan

• Call the medical or dental plan's member services department. They may be able to help you with your complaint.
• If member services staff cannot help you with your complaint, ask them to mail a grievance form to you at your home address. Your doctor or dentist also has grievance forms. Or you can send a letter to your medical or dental plan.
• Complete the grievance form. Mail the original to the medical or dental plan's member services department. Keep a copy for your records.
• Your medical or dental plan will review its decision based on your grievance. You will get an answer within 30 days. If you think waiting 30 days will harm your health, be sure to say that, and why, when you ask for your grievance. You might be able to get an answer within 3 days.

Report the problem to the California Department of Health Services State Ombudsman

• Call 1-888-452-8609, Monday through Friday, 8 a.m. to 5 p.m. PT, except holidays.

Report the problem to the California Department of Managed Health Care Office of Patient Advocacy

• Call 1-888-466-2219, 24 hours a day, seven days a week.

Ask for a State Fair Hearing with an Administrative Law Judge

• If you want a State Fair Hearing, you must ask for it within 90 days from the date of the “Notice of Action” or “Grievance Resolution” letter you got from your medical or dental plan, or from the date of the order or action your complaint is about.
• If the “Notice of Action” letter says the treatment you asked for is ended or reduced and you want to keep getting the treatment, you must ask for a State Fair Hearing within 10 days from the date the letter was postmarked or personally delivered to you, or 10 days before the effective date of the action you disagree with, whichever is earlier.
• Complete the “Form to File a State Fair Hearing” that came with your “Notice of Action” letter.
• You can also send a personal letter to ask for a State Fair Hearing. Include your name, address, phone number, Social Security number, and the reason you want a State Fair Hearing. If someone is helping you ask for a State Fair Hearing, write their name, address, and phone number in the letter.
• If you want to keep getting your treatment during the hearing process, be sure to state that on the “Form to File a State Fair Hearing” or in your personal letter.
• If you need a free interpreter, state that on the “Form to File a State Fair Hearing” or in your personal letter. Include the name of the language you speak.
• It takes up to 90 days after you ask for a hearing to get an answer. If you think waiting that long will hurt your health, ask your doctor or dentist, or medical or dental plan, for a letter. Make sure the letter explains how waiting will threaten your health. Then, ask for an expedited hearing. Include the letter with the “Form to File a State Fair Hearing” or with your own personal letter.
  • State Hearing
    Write to:
    California Department of Social Services
    State Hearing Division
    P.O. Box 944243, MS 19-37
    Sacramento, CA 94244-2430
    Phone: 1-800-952-5253 (TTY 1-800-952-8349)