What is a complaint (grievance)? What to do if you have a problem?
A grievance is a type of complaint that does not involve payment, denial or discontinuation of services by our health plan or our network providers. You might file a complaint for these reasons and more:
- You are unsatisfied with the quality of your care during a hospital stay
- You feel you are being encouraged to leave your plan
- You had to wait on the phone, at a network pharmacy, in the waiting room or in the exam room
- You are unhappy with the way your doctors, network pharmacists or others behave
- You are not able to reach someone by phone or get information you need
- There is a lack of cleanliness or the condition of the doctor's office
Who can file a complaint (grievance)?
You may file a complaint. Or, someone else may file the complaint for you with your permission.
Appointing a representative
You can name another person to act for you as your "representative" to ask for a complaint.
If you want a friend, relative, or other person to be your representative, call Member Services and ask for the "Appointment of Representative" form. You can also get the form on the Medicare website by clicking the link below. The form will give the person permission to act for you. You must give us a copy of the signed form with your request. The form must include:
- Your name, address and phone number
- Your Medicare Health Insurance Claim Number (HICN) number
- The name, address and phone number of your representative
- Include a statement that you are giving permission for the representative to act on your behalf and are giving permission for personal information to be given to your representative
- Is signed by you and your representative
- Include a statement that your representative agrees to act on your behalf
CMS Link to Appointment of Representative form
When can a complaint (grievance) be filed?
Complaints related to Medicare Part D must be made within 60 calendar days after you had the problem you want to complain about. There is no filing limit for complaints related to Medicare Part C or about quality of care.
When will the health plan respond?
If we cannot resolve your complaint within the next business day, we will send you a letter within 5 calendar days of receiving your complaint letting you know that we received it.
If you are making a complaint because we denied your request for a "fast coverage decision" or a "fast appeal," we will automatically give you a "fast complaint" and respond to your complaint within 24 hours. If you have an urgent problem that involves an immediate and serious risk to your health, you can request a "fast complaint" and we will respond within 72 hours.
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 do not come to a decision within 30 days, we will notify you in writing and provide a status update and estimated time for you to get the answer.
Where can a complaint (grievance) be filed?
Download the CareMore Cal MediConnect Plan GRIEVANCE FORM
Complete the Online CareMore Cal MediConnect Plan GRIEVANCE FORM
File complaints in writing to:
Attn: Appeals and Grievances
12900 Park Plaza Drive, Ste #150
Cerritos, CA 90703
To file a complaint over the phone, or for process and status questions, please call Member Services at 1-888-350-3447 (TTY: 711), Monday - Friday 8 a.m. to 8 p.m. PST, except on holidays, to:
- File a complaint over the phone
- Get a status on a filed complaint
- Learn more about our complaint process
If you feel you have used all your options with us, you may file a complaint directly with Medicare at Medicare.gov.
You may also contact the Medicare Ombudsman to get help with your rights and protections. You may also submit a Medicare complaint form.