Common use of Mental Health and Substance Abuse Services Clause in Contracts

Mental Health and Substance Abuse Services. Members, a designated representative, or a provider on behalf of the Member may contact the MHSA by telephone, letter, or online to request a review of an initial determination concerning a claim or service. Members may contact the MHSA at the telephone number provided below. If the telephone inquiry to the MHSA’s Customer Service Department does not resolve the question or issue to the Member’s satisfaction, the Member may submit a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate a grievance by submitting a letter or a completed “Grievance Form”. The Member may request this Form from the MHSA’s Customer Service Department. If the Member wishes, the MHSA’s Customer Service staff will assist in completing the Grievance Form. Completed Grievance Forms should be mailed to the MHSA at the address provided below. The Member may also submit the grievance to the MHSA online by visiting xxxx://xxx.xxxxxxxxxxxx.xxx. 0-000-000-0000 Blue Shield of California Mental Health Service Administrator

Mental Health and Substance Abuse Services. Members, a designated representative, or a provider on behalf of the Member may contact the MHSA by telephone, letter, or online to request a review of an initial determination concerning a claim or service. Members may contact the MHSA at the telephone number provided below. If the telephone inquiry to the MHSA’s Customer Service Ser- vice Department does not resolve the question or issue to the Member’s satisfaction, the Member may submit a grievance at that time, which the Customer Service Representative will initiate on the Member’s behalf. The Member, a designated representative, or a provider on behalf of the Member may also initiate initi- ate a grievance by submitting a letter or a completed com- pleted “Grievance Form”. The Member may request re- quest this Form from the MHSA’s Customer Service Ser- vice Department. If the Member wishes, the MHSA’s Customer Service staff will assist in completing the Grievance Form. Completed Grievance Forms should be mailed to the MHSA at the address provided below. The Member may also submit the grievance to the MHSA online by visiting xxxx://xxx.xxxxxxxxxxxx.xxxxxx.xxxxxxxxxxxx.xxx. 0-000-000-0000 Blue Shield of California Mental Health Service Administrator