What is a grievance?
As a Blue Shield of California Promise Cal MediConnect Plan member, you have a right to file a complaint (grievance) if you have a problem with your medical care or our services. Examples of the types of complaints you may submit include quality of care, waiting times, and the customer service you receive.
To check the status of a complaint you've already filed, and find information about what each status means, log in to your account to access your grievance status page.
How to file a grievance, step-by-step.
Step 1 – Contact us promptly
Contact Blue Shield Promise Cal MediConnect Member Services via phone, fax, or letter describing your grievance or file your grievance online:
Phone: (855) 905-3825 [TTY: 711], 8 a.m. to 8 p.m., seven days a week
Fax: (323) 889-5049
Blue Shield Promise Cal MediConnect Plan
Member Appeals and Grievances (Complaints) Department
601 Potrero Grande Dr., Monterey Park, CA 91755
Download grievance form (PDF, 98 KB)
Step 2 – We acknowledge receipt of your grievance
- We will acknowledge receipt of your written grievance within five (5) days of receiving it. We will conduct a review of your issues. We may request your medical records as part of our review.
- We will mail you a response to your complaint within thirty (30) days of receiving your complaint. We must address your grievance as quickly as your case requires based on your health status, but no later than thirty (30) days after receiving your complaint. We may extend the time frame by up to fourteen (14) days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest.
- 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."
- If we have requested to take an additional 14 days to resolve your appeal or complaint, and you believe we should not take extra days, you can file a "fast complaint."
- For expedited grievance requests or "fast complaints," we will respond within 24 hours. We will address your grievance as quickly as your case requires, based on your health status.
Step 3 – We review your complaint and give you our answer
- 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.
- Most complaints are answered in 30 calendar days. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more calendar days (44 days total) to answer your complaint.
- If we do not agree with some or all of your complaint or don't take responsibility for the problem you are complaining about, we will let you know. Our response will include our reasons for this answer. We must respond whether we agree with the complaint or not.
Medicare and the Cal MediConnect Ombuds Program can help you with complaints.
You can also tell Medicare about your complaint. Submit a complaint to Medicare online or call 1-800-MEDICARE ((800) 633-4227) / TTY: (877) 486-2048, 24 hours a day, seven days a week.
The Cal MediConnect Ombuds Program also helps solve problems from a neutral standpoint to make sure that our members receive all the covered services that we are required to provide. The Cal MediConnect Ombuds Program is not connected with us or with any insurance company or plan. The phone number for the Cal MediConnect Ombuds Program is (855) 501-3077. The services are free.
Complaint to the Quality Improvement Organization
When your complaint is about quality of care, you can make your complaint to the Quality Improvement Organization.
The Quality Improvement Organization (QIO) is a group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients. A complaint to QIO can be submitted without or in addition to making the complaint to Blue Shield of California Promise Health Plan.
Livanta (California's Quality Improvement Organization) contact information:
Phone: (877) 588-1123 (TTY: (855) 887-6668)
Fax: (833) 868-4063
Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
Complaint to the Office of Civil Rights at the Department of Health and Human Services
When your complaint is about disability access or about language assistance, you can file a complaint with the Office of Civil Rights at the Department of Health and Human Services.
- If you have a complaint about disability access or about language assistance, call the Department of Health and Human Services’ Office for Civil Rights at (800) 368-1019 (TTY: (800) 537-7697). You can also call your local Office for Civil Rights at (562) 908-8501.
- You may also have rights under the Americans with Disability Act and under ADA Amendments Act of 2008 (P.L. 110-325). You can contact the Cal MediConnect Ombuds Program for assistance (refer to contact information above).
For more information on the grievance process, refer to your Member Handbook.