DEPARTMENT OF MANAGED HEALTH CARE REVIEW. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. 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 unre- solved for more than 30 days, you may call the De- partment 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 neces- sity 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 De- partment also has a toll-free telephone number (0- 000-000-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Depart- ment’s Internet Web site (xxx.xxxx.xx.xxx) has complaint forms, IMR application forms and in- structions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion of benefits, you may request a review by the Department of Managed Health Care Director.
DEPARTMENT OF MANAGED HEALTH CARE REVIEW. The California Department of Managed Health Care 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 0-000-000-0000 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 (0-000-XXX-0000) and a TDD line (0- 000-000-0000) for the hearing and speech impaired. The Department’s Internet Web site (xxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms and instructions online. In the event that Blue Shield should cancel or refuse to renew the enrollment for you or your Dependents and you feel that such action was due to reasons of health or utilization of benefits, you or your Dependents may request a review by the Department of Managed Health Care Director.
