California Department of Managed Health Care
is responsible for regulating health care service plans. If you have a grievance
against OptumHealth Physical Health of California (OptumHealth), you should
first telephone OptumHealth at 1-800-428-6337
or for TDDY services call
1-888-877-5379 (voice), or
and use OptumHealth'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
has complaint forms, IMR application forms and instructions online.
If you believe your health coverage has been, or will be improperly cancelled, rescinded, or not renewed, you may also call the Department for assistance.
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