If you are unhappy with any aspect of your care or with Blue Shield of California Promise Health Plan, you may submit a complaint (grievance) at any time. We will resolve your concerns within 30 days of receiving your grievance.
If you think we have made a mistake in denying your medical service, or if you don’t agree with our decision, you can ask for an appeal. You must do this within 60 calendar days from the date on the Notice of Action sent to you. We will resolve your concerns within 30 days of receiving your complaint. However, if your appeal involves an immediate and serious threat to your health, we will respond to your appeal within 72 hours. This may include loss of life, limb, or major bodily function.
How to file a grievance or appeal
You may submit a grievance or an appeal online, by phone, by mail, or in person. Please review your Member Handbook (Evidence of Coverage) for guidelines on how to file a grievance or an appeal.
Blue Shield of California Promise Health Plan
601 Potrero Grande Dr.
Monterey Park, CA 91755
Fax: (323) 889-5049
Fill out a grievance or an appeal form available at your healthcare provider’s office.
Download an appeal and grievance form in your preferred language. Note: These forms can be used for both grievances and appeals:
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You may need to provide permission to release your medical records to your representative, or to support your case if you file a grievance, complaint, or appeal. If you find that you need to provide consent for this purpose, you may use the form below.
You may appoint any individual (such as a relative, friend, advocate, an attorney, or any physician) to act as your representative to file an appeal or file a grievance on your behalf. Please use the form below to appoint a representative to act on your behalf.
Appointment of Representative form (PDF, 150 KB)
To check the status of a grievance or an appeal you've already filed, log in to your account to access your grievance/appeal status page.
I have filed an appeal or grievance, but I still have questions.
Since many members have the same questions as you do, we have made this list of Frequently Asked Questions. If you still have questions, call the Customer Care number on your member ID card.