Members Section

Grievance Form


Instructions for Filing a Grievance - Step 1

You may submit a grievance in one of three ways:

To file a grievance online, first read this important information. To continue, check the box below to get to the online grievance form. Fill out the requested information completely. When you have filled out the entire form, click the SUBMIT button. Be sure to print a copy for your record. Upon filing you will receive an acknowledgement that your grievance has been received.
 

Kern Family Health Care resolves grievances within 30 days.

If your case involves an imminent and serious threat to the health of the patient, including, but not limited to, severe pain, potential loss of life, limb, or major bodily function, it will be classified as an expedited grievance. We will send you a written statement on the status of an expedited grievance within 3 days of receipt.

The California Department of Managed Health Care (DMHC) 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 1-800-391-2000 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-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.

California Department of Managed Health Care (DMHC) website: www.dmhc.ca.gov



 I've read the above information and am ready to fill out the grievance form


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