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 receipt of your complaint.
If you think we have made a mistake in denying your medical service or you don’t agree with our decision, you can ask for an appeal within 60 calendar days from the date on the Notice of Action sent to you. We will resolve your concerns within 30 days of receipt of your complaint; unless your appeal involves an immediate and serious threat to your health including loss of life, limb or major bodily function, your appeal will be resolved within 72 hours.
How to file a grievance or appeal
If you have a complaint, grievance, or appeal you may submit it online, by phone or in writing by mail, fax or in person. Please review your Member Handbook (Evidence of Coverage) for guidelines on how to file an appeal or grievance.
Blue Shield of California Promise Health Plan
601 Potrero Grande Dr.
Monterey Park, CA 91755
Fax: (323) 889-5049
Fill out a grievance or appeal form available at your provider’s office.
Download an appeal and grievance form in your preferred language:
- English (PDF, 125 KB)
- Spanish (PDF, 57 KB)
- Arabic (PDF, 177 KB)
- Armenian (PDF, 81 KB)
- Chinese (PDF, 415 KB)
- Farsi (PDF, 179 KB)
- Khmer (PDF, 60 KB)
- Korean (PDF, 320 KB)
- Russian (PDF, 219 KB)
- Tagalog (PDF, 86 KB)
- Vietnamese (PDF, 169 KB)
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.
Medical Records Release form (PDF, 348 KB).
Important message from the Department of Managed Health Care
The California Department of Managed Health Care is responsible for regulating healthcare service plans. If you have a grievance against your health plan, you should first telephone your health plan (Los Angeles:(800) 605-2556 (TTY: 711), San Diego:(855) 699-5557 (TTY: 711),) 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 an 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 (888) 466-2219 and a TDD line (877) 688-9891 for the hearing and speech impaired. The department's internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.
What to do if you do not agree with an appeal decision
If you filed an appeal and received a letter from Blue Shield of California Promise Health Plan telling you that we did not change our decision, or you never received a letter telling you of our decision and it has been past 30 days, you can:
- Ask for an Independent Medical Review (IMR) from DMHC and an outside reviewer who is not part of Blue Shield of California Promise Health Plan will review your case.
- Ask for a State Hearing from the California Department of Social Services (DSS), and a judge will review your case.
To learn more about how to request an Independent Medical Review or request a state hearing from DSS, please read your Member Handbook (Evidence of Coverage).