Medi-Cal Dental – Appeals and Grievances
Many issues or concerns can be promptly resolved by our Member Services Department. If you have not already done so, you may want to first contact Member Services.
Health Net encourages you to provide a detailed account of your experience. Your feedback is important to us and we appreciate the time you have taken to share this information. We hope that you will allow us to continue to serve you and provide the excellent service that you deserve.
If you believe a delay in the decision making may impose an imminent and serious threat to your health, please contact customer service using the toll-free telephone number on your ID card to request an expedited review.
File a GRIEVANCE FORM – Online
- Health Net Medi-Cal Medical & Dental Members: Log In to your account
- Health Net Medi-Cal Online Grievance Form
File a GRIEVANCE FORM – Mail or Fax
Download and print a GRIEVANCE FORM.
- Medi-Cal Dental – GRIEVANCE FORM – English (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Spanish (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Arabic (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Armenian (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Cambodian / Khmer (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Chinese (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Farsi (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Hmong (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Korean (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Russian (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Tagalog (PDF)
- Medi-Cal Dental – GRIEVANCE FORM – Vietnamese (PDF)
A message to State Health Program members, from the California Department of Managed Health Care
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 1-800-675-6110, TTY: 711 (Health Net of CA Customer Service for State Health Plans) 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 (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's internet website www.dmhc.ca.gov has complaint forms, IMR application forms and instructions online.