Medi-Cal Problems and Complaints

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role="navigation" aria-labelledby="pageNav"> <span id="pageNav"> <span class="Medi-Cal">Medi-Cal</span> <i href="#sideNav" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent=".accordian-menu"></i> </span> <div class="list-group panel" id="sideNav"> <a href="https://www.hpsm.org/member/medi-cal/eligibility" class="list-group-item strong "> Eligibility </a> <a href="https://www.hpsm.org/member/medi-cal/benefits" class="list-group-item dropdown-item collapsed "> Benefits & Services <i href="#group-154f66d73-5412-4ae0-8f4d-dd62957bd892" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-1022e58b3-d61e-4552-989f-46fd9ec9dd73"></i> </a> <div class="collapse" id="group-154f66d73-5412-4ae0-8f4d-dd62957bd892"> <a href="https://www.hpsm.org/member/medi-cal/benefits/enhanced-care-management" class="list-group-item strong "> Enhanced Care Management (ECM) </a> <a href="https://www.hpsm.org/member/medi-cal/benefits/community-supports" 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href="https://www.hpsm.org/member/medi-cal/where-can-i-get-care/emergency-medical-care" class="list-group-item strong "> Emergency Medical Care </a> </div> <a href="https://www.hpsm.org/member/medi-cal/get-your-initial-health-assessment" class="list-group-item strong "> Initial Health Assessment </a> <a href="https://www.hpsm.org/member/medi-cal/continuity-of-care" class="list-group-item strong "> Continuity of Care </a> <a href="https://www.hpsm.org/member/medi-cal/whole-child-model" class="list-group-item dropdown-item collapsed "> Whole Child Model <i href="#group-114390f98-fab6-40ea-8ec5-67e4740693ff" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-1022e58b3-d61e-4552-989f-46fd9ec9dd73"></i> </a> <div class="collapse" id="group-114390f98-fab6-40ea-8ec5-67e4740693ff"> <a href="https://www.hpsm.org/member/medi-cal/whole-child-model/qualifying-conditions" class="list-group-item strong "> Qualifying Conditions </a> </div> <a href="https://www.hpsm.org/member/medi-cal/ride-benefit" class="list-group-item strong "> Ride Benefit </a> <a href="https://www.hpsm.org/member/medi-cal/language-services" class="list-group-item strong "> Language Services </a> <a href="https://www.hpsm.org/member/medi-cal/resources" class="list-group-item dropdown-item collapsed "> Member Materials <i href="#group-15a440ed8-78c1-4c02-a475-7a3bf2d5b9a3" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-1022e58b3-d61e-4552-989f-46fd9ec9dd73"></i> </a> <div class="collapse" id="group-15a440ed8-78c1-4c02-a475-7a3bf2d5b9a3"> <a href="https://www.hpsm.org/member/medi-cal/resources/manuals" class="list-group-item strong "> Member Manuals </a> <a href="https://www.hpsm.org/member/medi-cal/resources/member-forms" class="list-group-item strong "> Member Forms </a> <a href="https://www.hpsm.org/member/medi-cal/resources/member-notices" class="list-group-item strong "> Member Notices </a> <a 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href="https://www.hpsm.org/member/medi-cal/medi-cal-quick-start-guide/hpsm-benefits" class="list-group-item strong "> HPSM Benefits </a> <a href="https://www.hpsm.org/member/medi-cal/medi-cal-quick-start-guide/other-programs-services" class="list-group-item strong "> Other Programs & Services </a> <a href="https://www.hpsm.org/member/medi-cal/medi-cal-quick-start-guide/dont-lose-your-medi-cal" class="list-group-item strong "> Don't Lose Your Medi-Cal </a> </div> <a href="https://www.hpsm.org/member/medi-cal/problems-and-complaints" class="list-group-item strong active"> Problems and Complaints </a> <a href="https://www.hpsm.org/member/medi-cal/nondiscrimination-notice" class="list-group-item strong "> Nondiscrimination Notice </a> <a href="https://www.hpsm.org/member/medi-cal/contact-us" class="list-group-item strong "> Contact Us </a> </div> </div> </div> <div class="related-items">  <div class="card"> <h3> </h3> <div class="name-and-phone-list"> <h5> </h5> <div > <div class="sfContentBlock sf-Long-text" ><h3 class="mt-4">New address or contact information?</h3><p>If you move and/or change your contact information (phone number, email), you must tell both HPSM and either the San Mateo County Human Services Agency at <span class="phone">1-800-223-8383</span> or Social Security Administration at <span class="phone">1-800-772-1213</span>. This will ensure that you continue to get important information about your Medi-Cal coverage status.</p><p>To report your new information with HPSM, you can <a target="_blank" href="/member-portal-login">log in to the Member Portal</a> or call the number below if you need assistance.</p><p class="my-4"><a class="btn btn-primary btn-wide" target="_blank" href="/member-portal-login">Log in to the Member Portal</a></p></div> </div> <div > <div class="sfContentBlock sf-Long-text" ><h3 id="call-member-services">Member Services</h3><p class="mt-1"><span class="nobreak">Toll free:</span> <span class="phone">1-800-750-4776</span> <br>Local: <span class="phone">650-616-2133</span> <br>TTY: <span class="phone">1-800-735-2929</span> or dial <span class="phone">7-1-1</span></p><p class="mt-1"><span class="nobreak">Phone hours: Monday–Friday</span> <span class="nobreak">8:00 a.m. to 6:00 p.m.</span> <br>Office hours: Monday–Friday 8:00 a.m. to 4:00 p.m.<br>Email: <a href="mailto:MemberServicesSupport@hpsm.org">MemberServicesSupport@hpsm.org</a></p></div> </div> <div > <div class="sfContentBlock sf-Long-text" ><h3 id="call-grievances">Grievance and Appeals Unit<br></h3><p style="margin-top: 8px">Toll free: <span class="phone">1-888-576-7227</span><br>Local: <span class="phone">650-616-2850</span> <br>Fax <span class="phone">650-829-2002</span> </p><p style="margin-top: 8px"><span class="nobreak">Monday–Friday</span> <span class="nobreak">8:00 a.m. to 5:00 p.m.</span></p></div> </div> <div > <div class="sfContentBlock sf-Long-text" ><h3 id="visit-us">Visit Us in Person</h3><p>Health Plan of San Mateo<br>801 Gateway Blvd., Suite 100<br>South San Francisco, CA 94080 - <a target="_blank" href="https://www.mapquest.com/us/california/south-san-francisco/94080-7401/801-gateway-blvd-37.66075,-122.39862">map<br></a>Hours are 8:00 a.m. to 4:00 p.m. Monday though Friday<a target="_blank" href="https://www.mapquest.com/us/california/south-san-francisco/94080-7401/801-gateway-blvd-37.66075,-122.39862"></a></p><p>Members can drop by our office to speak with a Member Services Representative in-person. No appointment is necessary. To help us better assist you, bring your Member ID card with you. Visitors only need to wear masks during private appointments. We have masks on hand for those who do not have them. Other health and safety precautions are in place as well. Our office is ADA-compliant and wheelchair accessible.</p><p>For more information about visiting HPSM’s office, call the HPSM Reception Desk at <span class="phone">650-616-0050</span>.<br></p></div> </div> </div> <div class="name-and-phone-list"> <h5> </h5> </div> <div class="name-and-phone-list"> <h5> </h5> </div> </div> </div> </div> <div class="col-xs-12 col-sm-8 col-sm-pull-4"> <div class="content-area container-fluid-margin"> <div class="sf_cols" data-sf-element="Row"> <div class="sf_colsOut sf_1col_1_100"> <div id="Contentplaceholder_TACCE306D001_Col00" class="sf_colsIn sf_1col_1in_100" data-sf-element="Column 1"><div class="plan-name mb-4"> <a href="/member">Member </a> <span> / </span> <a href="/member/my-health-plan">My Health Plan </a> <span> / </span> <a href="/member/medi-cal">Medi-Cal </a> </div> <div > <div class="sfContentBlock sf-Long-text" ><h1>Problems & Complaints</h1><p>If you are dissatisfied with your medical care or the service provided by HPSM or your doctor's office, we want to address and resolve it to your satisfaction. Our grievance and appeals process allows us to do this as quickly as possible.</p><p>Expressing concerns or filing a complaint will not affect your benefits in any way. Your provider (doctor) also cannot discriminate against you because you file a complaint.</p><h2>How to file a complaint</h2><p>First, <a href="/member/contact-member-services">call Member Services</a>; they will try to resolve your concern over the phone. If we do not resolve your complaint to your satisfaction within 24 hours, the Grievance and Appeals Unit will start a formal process to reach a solution.</p><h2>Grievance and Appeals</h2><h4>There are two types of complaints, a grievance and an appeal</h4><ol style="margin-top: 20px"><li><span class="h5">File a grievance</span> if you are dissatisfied about the medical services or customer service you received from HPSM or a provider. <br></li><li><span class="h5">File an appeal</span> if you want HPSM to reconsider a decision to deny coverage for a service or item you or your doctor requested. You must file the appeal within 60 days of the denial.</li></ol><h4>There are four ways you can file a grievance</h4><ol style="margin-top: 20px"><li><span class="h6">Online:</span> Fill out and submit our online <a href="https://grievance.hpsm.org/" target="_blank" title="Confidential Member Complaint Form">confidential member complaint form</a>.</li><li><span class="h6">By phone:</span> Call Member Services at <span class="phone">1-800-750-4776</span> (toll-free) or <span class="phone">650-616-2133</span>.</li><li><span class="h6">In writing:</span> Download and complete our printable <a href="/docs/default-source/member-forms/confidential_member_complaint_form_english.pdf?sfvrsn=34980729_37" target="_blank" title="Confidential Member Complaint Form ">member complaint form</a>, then fax it to <span class="phone">650-829-2002</span> or mail it to the address printed on the form.</li><li><span class="h6">In person:</span> Visit our office to speak face-to-face with a representative about your grievance. </li></ol><h4>There are two ways you can file an appeal</h4><ol style="margin-top: 20px"><li><span class="h6">By phone:</span> Call a Member Services Representative at <span class="phone">1-800-750-4776</span> (toll-free) or <span class="phone">650-616-2133</span>.</li><li><span class="h6">In person:</span> Visit our office to speak face-to-face with a representative about your appeal.</li></ol><h2>Complaints about emergency situations</h2><p>If your complaint involves an imminent and serious threat to your health (including but not limited to severe pain, potential loss of life, limb or major bodily function), you or your provider may request an expedited (fast-tracked) review. If your complaint qualifies, we will resolve it within three days of receipt.</p><h2>After you file a complaint</h2><p>Within five days, we will send an acknowledgement letter confirming receipt of your complaint. We will resolve your complaint within 30 days and send you a letter explaining our decision. To ask about the status of an existing complaint, call our Grievance and Appeals Unit. </p><p>Any services that were authorized will continue to be provided until your complaint is resolved.</p></div> </div> </div> </div> </div> <div > <div class="sfContentBlock sf-Long-text" ></div> </div> <div class="page-documents"> <h3></h3> <div class="color-tabs notranslate"> <ul style="list-style-type:none;padding-left:0;" class="nav nav-tabs responsive-tabs" role="tablist"> <li class="lang-en active" role="tab" aria-controls="panelen" aria-selected="false"> <a href="#panelen" tabindex="1">English</a> </li> <li class="lang-es " role="tab" aria-controls="paneles" aria-selected="false"> <a href="#paneles" tabindex="2">Spanish</a> </li> <li class="lang-zh " role="tab" aria-controls="panelzh" aria-selected="false"> <a href="#panelzh" tabindex="3">Chinese</a> </li> <li class="lang-fil " role="tab" aria-controls="panelfil" aria-selected="false"> <a href="#panelfil" tabindex="4">Filipino</a> </li> <li class="lang-ru " role="tab" aria-controls="panelru" aria-selected="false"> <a href="#panelru" tabindex="5">Russian</a> </li> </ul> <div class="tab-content"> <div class="tab-pane active first" id="panelen" role="tabpanel" aria-labelledby="taben" aria-hidden="true"> <a href="https://www.hpsm.org/docs/default-source/member-forms/confidential_member_complaint_form_english.pdf?sfvrsn=34980729_37" role="button" target="_blank" class="download" tabindex="1">Confidential Member Complaint Form <span></span></a> <a href="https://www.hpsm.org/docs/default-source/member-notices/member_rights_in_complaint_process.pdf?sfvrsn=679b5f0f_25" role="button" target="_blank" class="download" tabindex="1">Member Rights in the Complaint Process <span></span></a> </div> <div class="tab-pane " id="paneles" role="tabpanel" aria-labelledby="tabes" aria-hidden="true"> <a href="https://www.hpsm.org/docs/default-source/member-forms/confidential_member_complaint_form_spanish.pdf?sfvrsn=34980729_37" role="button" target="_blank" class="download" tabindex="2">Formulario de queja confidencial del miembro <span></span></a> <a href="https://www.hpsm.org/docs/default-source/member-notices/members-right-(grievance)-2023-sp325869dcc89b46559816439bcf3e9cd6.pdf?sfvrsn=679b5f0f_25" role="button" target="_blank" class="download" tabindex="2">Derechos de los miembros <span></span></a> </div> <div class="tab-pane " id="panelzh" role="tabpanel" aria-labelledby="tabzh" aria-hidden="true"> <a href="https://www.hpsm.org/docs/default-source/member-forms/confidential_member_complaint_form_chinese.pdf?sfvrsn=34980729_37" role="button" target="_blank" class="download" tabindex="3">保密會員投訴表 <span></span></a> <a href="https://www.hpsm.org/docs/default-source/member-notices/members-right-(grievance)-2023-chcacc0ab0690e41f1ae22daba0a0b4f4fcacc0ab0690e41f1ae22daba0a0b4f4f.pdf?sfvrsn=679b5f0f_25" role="button" target="_blank" class="download" tabindex="3">會員權利 <span></span></a> </div> <div class="tab-pane " id="panelfil" role="tabpanel" aria-labelledby="tabfil" aria-hidden="true"> <a href="https://www.hpsm.org/docs/default-source/member-forms/confidential_member_complaint_form_tagalog.pdf?sfvrsn=34980729_37" role="button" target="_blank" class="download" tabindex="4">Form para sa Kumpidensiyal na Reklamo ng Miyembro <span></span></a> <a href="https://www.hpsm.org/docs/default-source/member-notices/members-right-(grievance)-2023-taa08bdea1495a45f9975548b116d74531a08bdea1495a45f9975548b116d74531.pdf?sfvrsn=679b5f0f_25" role="button" target="_blank" class="download" tabindex="4">Mga Karapatan Ng Miyembro <span></span></a> </div> <div class="tab-pane " id="panelru" role="tabpanel" aria-labelledby="tabru" aria-hidden="true"> <a href="https://www.hpsm.org/docs/default-source/member-forms/confidential_member_complaint_form_russian.pdf?sfvrsn=34980729_37" role="button" target="_blank" class="download" tabindex="5">Бланк жалобы для конфиденциального обращения участника <span></span></a> </div> </div> </div> </div> <div > <div class="sfContentBlock sf-Long-text" ><div class="callout callout-info"><p>For more information about reporting complaints and solving problems, refer to section 6 of <a href="/docs/default-source/member-manuals/medi-cal-member-handbook-english.pdf?sfvrsn=fa21ef70_58" title="Medi-Cal 2023 Member Handbook / Evidence of Coverage">Medi-Cal 2023 Member Handbook / Evidence of Coverage</a>. To order a printed Member Handbook, email <a href="mailto:CustomerSupport@hpsm.org">CustomerSupport@hpsm.org</a> or <a href="/member/contact-member-services">call Member Services</a>.  </p></div></div> </div> </div> <div class="container-fluid-margin"> </div> </div> </div> </div>  <div class="pre-footer reveal-fade-in"> <div class="container-fluid"> <div class="row"> <div class="col-sm-12"> </div> </div> </div> </div> </main> <footer> <div class="row pb-3"> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <img style="width:150px;" role="presentation" src="/assets/_img/hpsm-logo.png" /> <p class="notranslate"><span class="block">801 Gateway Blvd., Suite 100</span><span class="block">South San Francisco, CA 94080</span></p> <p> Phone: <span style="color:#2e9947;">650-616-0050</span> <br />Fax: <span style="color:#2e9947;">650-616-0060</span> <br />TTY:  <span style="color:#2e9947;">1-800-735-2929</span> <br />or dial <span style="color:#2e9947;">7-1-1</span> </p> <p class="mt-3"> <a style="margin-left:0.5rem;margin-right:1.0rem;" rel="noreferrer" target="_blank" href="https://www.facebook.com/healthplanofsanmateo"> <img style="display: inline;" width="24" height="24" src="https://www.hpsm.org/images/default-source/logos/facebook.svg?Status=Temp&sfvrsn=ac66c4ba_2" role="presentation" alt="facebook" /> </a> <a style="margin-left:1.0rem;" target="_blank" rel="noreferrer" href="https://www.instagram.com/healthplanofsanmateo/"> <img style="display: inline;" width="24" height="24" src="https://www.hpsm.org/images/default-source/logos/instagram.svg?Status=Temp&sfvrsn=d4ddac80_2" role="presentation" alt="instagram" /> </a> </p> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <a id="MemberFooterLink" class="text-lg text-capitalize" title="Members" href="/member">Members</a> <a id="ProviderFooterLink" class="text-lg notranslate" title="Providers" href="/provider">Providers</a> <a id="HealthTipsFooterLink" class="text-lg" title="Health Tips" href="/health-tips">Health Tips</a> <a id="CareerFooterLink" class="text-lg" title="Careers" href="/job-seeker">Careers</a> <a id="AboutUsFooterLink" class="text-lg" title="About HPSM" href="/about-us">About HPSM</a> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <ul style="line-height:1.5rem;"> <li class="nav-item"><a id="ContactFooterLink" href="/contact-us">Contact Us</a></li> <li class="nav-item"><a id="LanguageFooterLink" href="https://www.hpsm.org/docs/default-source/member-notices/language-assistance-tagline.pdf">Language Assistance</a></li> <li class="nav-item"><a id="PrivacyFooterLink" href="/privacy-policy">Privacy Policy</a></li> <li class="nav-item"><a id="NDNFooterLink" href="/non-discrimination-notice">Non-Discrimination Notice</a></li> <li class="nav-item"><a id="AccessibilityFooterLink" href="/help/accessibility">Accessibility Statement</a></li> <li class="nav-item"><a id="ComplianceFooterLink" href="/about-us/governance/compliance">Compliance</a></li> </ul> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <div id="tagline"> <p>Helping San Mateo County’s vulnerable and underinsured residents live the healthiest lives possible.</p> </div> <br /><br /> <small class="notranslate">Ⓒ 2024 Health Plan of San Mateo</small> </div> </div> </div> </footer>  <script src="/assets/_js/vendor/jquery.easing.1.3.js" type="text/javascript"></script> <script src="/assets/_js/vendor/bootstrap.min.js" type="text/javascript"></script> <script src="/assets/_js/vendor/jasny-bootstrap.js" type="text/javascript"></script> <script src="/assets/_js/vendor/enquire.min.js" type="text/javascript"></script> <script src="/assets/_js/vendor/jQuery.headroom.js" type="text/javascript"></script> <script src="/assets/_js/vendor/hoverIntent.js"></script> <script src="/assets/_js/vendor/jquery.matchHeight.js" type="text/javascript"></script> <script src="https://unpkg.com/scrollreveal/dist/scrollreveal.min.js"></script> <script src="/assets/_js/vendor/bootstrap-responsive-tabs.min.js" type="text/javascript"></script> <script src="/assets/vendor/cubeportfolio/js/jquery.cubeportfolio.min.js"></script>  <script src="/assets/_js/hs.core.js"></script> <script src="/assets/_js/hs.cubeportfolio.js"></script> <script src="/assets/_js/main.js" type="text/javascript"></script> <script src="/Frontend-Assembly/Telerik.Sitefinity.Frontend.Search/Mvc/Scripts/SearchBox/Search-box.min.js?v=MTMuMy43NjQwLjA%3d" type="text/javascript"></script> </body> </html>

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