Apelaciones y quejas

Nuestro Departamento de Servicios para Afiliados puede resolver rápidamente muchos de sus problemas o preocupaciones. Si aún no lo ha hecho, es posible que primero quiera contactar a Servicios para Afiliados antes de enviar una apelación o queja.

Consejo para afiliados: Compruebe el reverso de su tarjeta de identificación para ver la información de contacto por teléfono.

Filing an Appeal or Grievance Process Description

Health Net has a formal process for reviewing member grievances and appeals. This process provides a uniform and equitable treatment of your grievance/appeal and a prompt response.

Health Net ensures all enrollees have access to and can fully participate in the grievance system by providing assistance for those with limited English proficiency or with visual or other communicative impairment. Such assistance shall include, but not be limited to, translation of grievance procedures, forms, and plan responses to grievances, as well as access to interpreters, telephone relay systems and other devices that aid disabled individuals to communicate.

If you wish to have another person file on your behalf, an authorized representative must be appointed in writing using either our authorization form or some other form of written notification. The "Authorized Representative" form is available at a Plan Facility, on our website at Healthnet.com, or by calling our Member Service Contact Center at the phone number listed on the back of your member ID Card.

Once your grievance or appeal has been submitted to us, we will contact you to acknowledge that we received it. Your case will be investigated by an Appeals and Grievance Case Coordinator, and we will ensure that the appropriate parties review your concern. We will make every attempt to resolve your issue promptly. The resolution of your grievance or appeal will then be communicated to you.

You can file a grievance or appeal online, by phone, by fax, in-person, or by mail. If you want us to consider your complaint, grievance, or appeal on an urgent basis, please tell us that when you file your grievance.

1. If you’d like assistance with this form or filing a grievance by phone, contact Member Services at the phone number listed on the back of your member ID Card.
2. Filing a grievance online, select your plan specific link below.
3. Filing by mail or fax, the grievance form can be downloaded and mailed or faxed to:
   
   Health Net of California
   Member Appeals and Grievance Department
   P.O. Box 10348
   Van Nuys, CA 91410-0348
   
   Fax: (877) 831-6019