The formal name for “making a complaint” is “filing a grievance.” A grievance is the kinds of problems related to:
- Quality of your medical care
- Respecting your privacy
- Disrespect, poor customer service, or other negative behaviors
- Physical accessibility
- Waiting times
- Information you get from our plan
- Language access
- Communication from us
- Timeliness of our actions related to coverage decisions or appeals
How to file a Grievance with IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan)
1. Contact us promptly – call IEHP DualChoice Member Services at 1-877-273-IEHP (4347), 8am - 8pm, 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. You can make the complaint at any time unless it is about a Part D drug. If the complaint is about a Part D drug, you must file it within 60 calendar days after you had the problem you want to complain about.
If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us. If you put your complaint in writing, we will respond to your complaint in writing.
- You can use our "Member Appeal and Grievance Form." All of our Doctor’s offices and service providers have the form or we can mail one to you. You can file a grievance online . You can give a completed form to our Plan provider or send it to us at the address listed below, or fax the completed form to the fax number listed below. This form is for IEHP DualChoice as well as other IEHP programs.
P.O. Box 1800
Rancho Cucamonga, CA 91729-1800
Whether you call or write, you should contact IEHP DualChoice Member Services right away.
2. We will look into your complaint and give you our answer
- If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer on the same phone call. If your health condition requires us to answer quickly, we will do that.
- Most complaints are answered in 30 calendar days. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more days (44 days total) to answer your complaint.
- If we do not agree with some or all of your complaint or don’t take responsibility for the problem you are complaining about, we will let you know. Our response will include our reasons for this answer. We must respond whether we agree with the complaint or not.
If you are making a complaint because we denied your request for a “fast coverage determination” or fast appeal, we will automatically give you a “fast” complaint. If you have a “fast” complaint, it means we will give you an answer within 24 hours.
Who may file a grievance?
You or someone you name may file a grievance. The person you name would be your “representative.” You may name a relative, friend, lawyer, advocate, doctor, or anyone else to act for you. Other persons may already be authorized by the Court or in accordance with State law to act for you. If you want someone to act for you who is not already authorized by the Court or under State law, then you and that person must sign and date a statement that gives the person legal permission to be your representative. To learn how to name your representative, you may call IEHP DualChoice Member Services.
You can tell Medicare about your complaint
You can send your complaint to Medicare. The Medicare Complaint Form is available at:
Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program.
If you have any other feedback or concerns, or if you feel the plan is not addressing your problem, please call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users can call 1-877-486-2048. The call is free.
You can tell Medi-Cal about your complaint
The Cal MediConnect Ombuds Program also helps solve problems from a neutral standpoint to make sure that our members get all the covered services that we must provide. The CalMediConnect Ombuds Program is not connected with us or with any insurance company or health plan. The phone number for the Cal MediConnect Ombuds Program is 1-855-501-3077. The services are free.
You can tell the California Department of Managed Health Care about your Complaint
The California Department of Managed Health Care (DMHC) is responsible for regulating health plans. You can call the DMHC Help Center for help with complaints about Medi-Cal services. You may contact the DMHC if you need help with a complaint involving an urgent issue or one that involves an immediate and serious threat to your health, you disagree with our plan’s decision about your complaint, or our plan has not resolved your complaint after 30 calendar days.
Here are two ways to get help from the Help Center:
- Call 1-888- 466-2219. Individuals who are deaf, hard of hearing, or speech-impaired can use the toll free TTY number, 1-877-688-9891. The call is free.
- Visit the Department of Managed Health Care’s website (http://www.HealthHelp.ca.gov).
You can file a complaint with the Office for Civil Rights
You can make a complaint to the Department of Health and Human Services’ Office for Civil Rights if you think you have not been treated fairly. For example, you can make a complaint about disability access or language assistance. The phone number for the Office for Civil Rights is 1-800-368-1019. TTY users should call 1-800-537-7697. You can also visit https://www.hhs.gov/ocr/index.html for more information.
You may also contact the local Office for Civil Rights office at:
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
You may also have rights under the Americans with Disability Act. You can contact the Cal MediConnect Ombuds Program for assistance. The phone number is 1-855-501-3077.
When your complaint is about quality of care
You have two extra options:
- You can make your complaint to the Quality Improvement Organization. If you prefer, you can make your complaint about the quality of care you received directly to this organization (without making the complaint to our plan). To find the name, address, and phone number of the Quality Improvement Organization in your state, look in Chapter 2 of yourIEHP DualChoice Member Handbook. If you make a complaint to this organization, we will work with them to resolve your complaint.
- Or you can make your complaint to both at the same time. If you wish, you can make your complaint about quality of care to our plan and also to the Quality Improvement Organization.
For more information on Grievances see Chapter 9 of yourIEHP DualChoice Member Handbook.
Handling problems about your Medi-Cal benefits
If you have Medi-Cal with IEHP and would like information on how to pursue appeals and grievances related to Medi-Cal covered services, please call IEHP DualChoice Member Services at 1-877-273-IEHP (4347), TTY at 1-800-718-4347, 8am - 8pm (PST), 7 days a week, including holidays.
IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
Information on this page is current as of October 15, 2018.