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Grievance & Appeal Procedures


Health Plan Member Services staff are available 8 a.m. to 5 p.m. Monday - Friday. However, If on a weekend or holiday, you need to file a grievance or appeal pertaining to a clinically urgent issue that involves an imminent and serious threat to your health, please call the Health Plan Advice Nurse for immediate assistance. The Advice Nurse is open 24 hours every day (877-661-6230 Option 1)

If you have a serious medical condition or have a medical question please call our 24-hour Advice Nurse Line at 1-877-661-6230, press 1 for assistance.

For all other member questions that need an immediate response, please contact the Member Services Department at 1-877-661-6230, press 2.

For medical emergencies, call 9-1-1.

How to File A Grievance

A grievance is an issue regarding the care or services you received that you are unhappy about.

If you are a CCHP member, you have the right to file a grievance. You can contact CCHP at 1-877-661-6230, press #1 or TTY/TDD 1-800-735-2929, to resolve a concern you may have or to get more information on how to file a grievance. You may want to also refer to your Evidence of Coverage for more detailed information. CCHP wants to make sure you are a happy member. If you are not happy about a problem or concern you had and want to file a grievance with us, there are many ways you can do it. The first and quickest way to get assistance with an issue is to contact our Member Services Unit by simply calling 1-877-661-6230, press #1 Monday through Friday between 8 a.m. and 5 p.m. We are here to assist you and want to help solve your problem quickly.

OR if you prefer, you can write us:

Simply write down the problem you are having and send it to:
Member Appeals/Grievance Resolution Unit
595 Center Avenue Suite 100
Martinez, CA 94553

Health Plan Member Services staff are available 8 a.m. to 5 p.m. Monday - Friday. However, If on a weekend or holiday, you need to file a grievance or appeal pertaining to a clinically urgent issue that involves an imminent and serious threat to your health, please call the Health Plan Advice Nurse for immediate assistance. The Advice Nurse is open 24 hours every day (877-661-6230 Option 1)

OR You can fax us:

Our fax number is 925-313-6047.

OR the Internet:

You can email us at cchp@hsd.cccounty.us or you can submit a grievance online.

OR You can visit us:

You can visit and speak personally to a Member Services Representative who can assist you with submitting your grievance.

Once CCHP has received your grievance you will receive a letter from us telling you that we have received it. The letter will also give you information relating to your grievance. All grievances must be resolved within 30 calendar days.

If you would like to have CCHP work with someone other than you on your grievance, please complete the Appointment of Representation Statement (PDF) and mail it with your grievance to the address above. CCHP must receive the completed and signed Appointment of Representation Statement before your grievance can be handled by someone other than you, the member.

How to file an Appeal

All of the following information can be found in your EOC located at the bottom of the page.

An appeal is a type of complaint you make when you want CCHP to reconsider or change a decision we have made. There are two kinds of appeals, standard and fast. Standard appeals must be reviewed within 30 days. Fast or Expedited appeals are reviewed in 72 hours and must meet certain requirements to qualify as a fast appeal.

If you are a member of CCHP you have the right to file an appeal. You can contact CCHP at 1-877-661-6230, press 1 or TTY/TDD 1-800-735-2929 to resolve a concern you may have or to get more information on how to file an appeal.

Additional information on the Appeal process can be found in your Evidence of Coverage (PDF) under, "How to file an Appeal." You may also contact our dedicated Member Services Staff to aid in you completing your Appeal request.

If you would like a family member or friend to represent you through the appeal process you must submit a Appointment of Representation Statement (PDF). This form must be completely filled out and signed by you and by the person representing you. Send this form in with your request for an appeal.

Send your appeal in writing to:

Member Appeals/Grievance Resolution Unit
595 Center Avenue Suite 100
Martinez, CA 94553

CCHP will send you a letter letting you know we have received your request for an appeal. CCHP has 30 days to complete the review of your appeal request.

Contact our Member Services department for any additional questions you may have. We can be reached Monday - Friday 8 a.m. to 5 p.m. We can help you through this process, please call us if you have any questions.

Health Plan Member Services staff are available 8 a.m. to 5 p.m. Monday - Friday. However, If on a weekend or holiday, you need to file a grievance or appeal pertaining to a clinically urgent issue that involves an imminent and serious threat to your health, please call the Health Plan Advice Nurse for immediate assistance. The Advice Nurse is open 24 hours every day (877-661-6230 Option 1)

Online Grievance form instructions

Our secure online grievance form makes it easy to submit your statement. Simply type in the requested information, answer the questions as completely as possible and don't forget to press the submit button. If you experience any difficulties with this form, please contact us at 1-877-661-6230 Monday - Friday 8 a.m. - 5 p.m. for assistance.

If you would like a family member or friend to represent you through this process you must submit a Appointment of Representation Statement (PDF). This form must be completely filled out and signed by you and by the person representing you. Send this form to CCHP at the above address when you complete the online grievance form. Instructions on completing the Appointment of Representation Statement can be found below.

Appointment of Representation Statement Instruction

Section 1: Appointment of Representative requests information about the CCHP member. The CCHP member information and the name of whom they want to represent them goes in this section.

Section 2: Acceptance of Appointment is to be completed by the representative.

Section 3: This section should be filled out if the representative waives a fee for such representation. A signature is required.

Double check your form and submit it with your written grievance or appeal request.

Double check your form and submit it with your written grievance or appeal request.

Possibility of Contract Termination

Contra Costa Health Plan (CCHP) has a Medi/Cal contract with the California Department of Health Care Services (DHSC). At the end of each year, this contract is reviewed and either CCHP or DHCS can decide to end it. In this situation, members will get 90 days advance notice. It is also possible for our contract to end at some other time of the year. In this situation, CCHP will try to tell members 90 days in advance, but this advance notice may be as short as 30 or fewer days if DHCS must end our contract in the middle of the year.

Whenever a Medi/Cal contract with a health plan is terminated, members will be given a special enrolment period to choose another Medi/Cal plan.