- Participating Physician Groups (PPG)
(does not apply to HSP)
Members may submit grievances orally or in writing to the Member Appeals and Grievance Department.
Health Net acknowledges receipt of the grievance within five calendar days, and sends a final resolution/disposition letter to the member within 15 calendar days for PPO members and 30 calendar days for HMO. If the case exceeds the 15 day PPO time limit or the 30-day HMO time limit, an interim letter of explanation is sent to the member by the 30th calendar day indicating the reason for the delay and providing an estimated resolution date. The written resolution is made as soon as possible and not to exceed 15 additional calendar days.
If the grievance involves an imminent and serious threat to the member's health, including but not limited to severe pain, potential loss of life, limb or major bodily function, the member or the provider may request that Health Net expedite its grievance review. When Health Net evaluates and determines the expedited grievance request to be urgent, the grievance is resolved within 72 hours from receipt of the request.
Members may obtain additional information about member grievance procedures in the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI).
DMHC Notices of Translation Assistance, Forms and Applications
DMHC Notices of Translation Assistance
Participating providers are required to insert a notice of translation assistance when corresponding with applicable members. Health Net-specific, DMHC notices of translation assistance are available on the Health Industry and Collaboration Effort (ICE) website at www.ICEforhealth.org > Library > Approved ICE Documents > Cultural & Linguistics Team folder. For additional information, providers can contact the Cultural and Linguistic Services Department.
Translated DMHC Complaint (Grievance) Forms
Physicians and ancillary providers must know how to locate and provide translated DMHC complaint (grievance) forms to members upon request. These forms are available in English, Chinese and Spanish on the DMHC website at www.dmhc.ca.gov.
Translated DMHC IMR Applications
Physicians and ancillary providers must know how to locate and provide translated DMHC IMR applications to members upon request. These applications are available in English, Chinese and Spanish on the DMHC website at www.dmhc.ca.gov.
Ancillary Providers and Notice of Language Assistance
Ancillary providers are required to include a notice of language assistance services when sending vital documents to applicable Health Net members. For assistance in determining if a document being sent to a Health Net member meets the vital document criteria, contact the Cultural and Linguistic Services Department.