Grievance Form (California DHMO Members only)

Grievance Form (California DHMO Members only)

Grievance Information

This form is for California DHMO Members only.

on card
  • If "XXX XX 1234" is displayed on your ID card, enter your full Social Security Number. Do not type the X's.
  • The Identification Number is the same for everyone covered on this policy.
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Dentist Information

Grievance Process

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 1 866-357-3304 (and use your health plan's grievance process before contacting the department).

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Grievance Resolution Procedure Grievance Resolution Procedure PDF