A member, or his or her physician or other representative, may file a grievance on behalf of the member anytime according to the current federal regulations, Title 42, CFR, Section 438.402(c)(i). Grievances filed by the member's physician or other representative, on behalf of the member, require written consent from the member or authorized representative. Members may submit grievances verbally or in writing by contacting the Health Net Medi-Cal Member Appeals and Grievances Department.

Members may obtain a member grievance/complaint form from their providers' office, or they may contact the Health Net Medi-Cal Member Services Department, Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department for assistance. The Member Grievance/Complaint forms are available online for Health Net Medi-Cal members.

A member grievance is an oral or written expression of dissatisfaction or concern that does not involve a prior determination. Member grievances include quality of care concerns, access to care concerns, complaints regarding delays of referrals or authorizations, and provider refusals to submit medical records. There are two types of member grievances:

Member grievances may be submitted orally or in writing any time. The first step in registering a grievance is to call the Health Net Medi-Cal Member Services Department, Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties).

The second step is to submit it in writing with the following information:

Health Net members are notified in writing of receipt of a grievance within five calendar days.

Members are informed in writing of resolution of the grievance within 30 calendar days. If resolution of the case exceeds 30 calendar days, Health Net will send the member a letter of explanation by the 30th calendar day, documenting the reason for the delay and an estimated completion date for the resolution.

A Health Net Appeals & Grievances Case Coordinator handles the grievance and corresponds with the provider, including requesting any additional information necessary. Upon receipt, the Case Coordinator forwards the case to a Health Net Clinician for review of all clinical grievances. For Non-Clinical grievances, the Case Coordinator will handle to resolve. In both instances the member will receive a written resolution.

Information gathered by Health Net, and as a result of the review of quality-related grievances that involve a provider, is considered confidential and protected from disclosure as quality of care-related peer review activities under California law. Member grievances related to a request for reassignment or disenrollment of a Medi-Cal member are referred to the Health Net Medi-Cal Member Services Department.

A member, or his or her physician or other representative, may file a grievance on behalf of the member anytime according to the current federal regulations, Title 42, CFR, Section 438.402(c)(i). Grievances filed by the member's physician or other representative, on behalf of the member, require written consent from the member or authorized representative. Members may submit grievances verbally or in writing by contacting the Health Net Medi-Cal Member Appeals and Grievances Department.

Members have a right to access their medical records. Written authorization from the member or the member’s authorized legal representative must be obtained before medical records are released to anyone not directly concerned with the member's care, except as permitted or as necessary for administration by the Health Plan.

Members who have a grievance against Health Net should contact Health Net and use its grievance process. However, members may also contact the California Department of Social Services (DDS) or the Department of Managed Health Care (DMHC) for assistance with an emergency grievance or with a grievance that has not been satisfactorily resolved by Health Net.