6 ·
My Health
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Let us interpret
What to do if you get
a Notice of Action
A Notice of Action is a formal letter you get from
us. It tells you that a medical service has been
denied, delayed or changed. If you get a Notice
of Action from us and are not happy with it, you
have three options:
1
You can file an appeal with us if you disagree
with what is in the letter. You can also request
a State Fair Hearing at the same time. But you must
file the appeal within 90 days from the date on the
Notice of Action.
2
You also may request a State Fair Hearing
from the Department of Social Services if you
disagree with what is in the Notice of Action. But you
must request the State Fair Hearing within 90 days
of the date of the letter. A State Fair Hearing allows
you to take your case to the state even if you filed
a complaint, grievance or appeal with us and your
issue was solved. To ask for a State Fair Hearing,
call
1-800-952-5253
. Your doctor also can ask for a
State Fair Hearing for you.
3
You may ask for an Independent Medical
Review (IMR) from the Department of Managed
Health Care if you disagree with what is in the
Notice of Action. But you can’t request an IMR
if you have already requested a State Fair Hearing
for the same issue.
You can request an IMR up to six months from the
date you get a Notice of Action from us. Materials
on how to file an IMR will come with your Notice
of Action.
If you have a problem or complaint about the care
you get from a provider in your plan, you can
file a complaint by phone or in writing within
180 days of when the problem started. You can
file your complaint through us or through your
doctor’s office.
We can help you with your problem
Just call the Customer Care Center number on
the back of your ID card to speak with someone
who can help you. The phone number is on the
back page of this newsletter. Most problems can be
solved quickly. If not, someone will help you file a
complaint by phone.
If you would rather talk to someone in a language
other than English, please call the Customer
Care Center number on the back of your ID card
and ask. We will get someone who speaks your
language. That person can help translate your
complaint as well.
What to do if you
have a complaint
You can also file your complaint in writing. Call
the Customer Care Center number on the back of
your ID card, and we will mail you a form.
After you fill out the form, mail it to:
Attn: Grievance Coordinator
Anthem Blue Cross Partnership Plan
PO Box 9054
Oxnard, CA 93031-9054
After you mail or call with a complaint, we
will send you a letter:
•
Within five days of getting your form to
let you know we are looking into your
complaint (grievance).
•
Within 30 days of getting your form to let
you know how we resolved the problem.
If your case has to do with a serious or immediate
threat to your health, we will respond within three
days of getting your form.
To learn more about how to file a complaint, check
your Member Services Guide.
We can help you no matter your preferred language.
We have a free interpretation service. Just call us at
1-800-407-4627
during office hours. Ask for translation
services in the language you prefer. You also can call our
24/7 NurseLine after hours at
1-800-224-0336
.
You can ask for written materials about your benefits
to be read to you over the phone in your language.
Or you can get them in writing in that language.
Just call the number at left. If you have hearing
or speech loss, you can call the TTY line
at
1-888-757-6034
.
Podemos traducir esto gratuitamente. Llame al número
de servicio de atención al cliente que aparece en su
tarjeta de identificación (ID card).
