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Grievance & Appeal Procedures

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 member of SeniorHealth, you have the right to file a grievance. You can contact SeniorHealth at 1-877-661-6230 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. SeniorHealth 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 Monday through Friday between 8 a.m. and 8 p.m. We are here to assist you and want to help solve your problem quickly.

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

You can fax us

Our fax number is 925-313-6047
If your fax is received after hours or on the weekend we will receive it the next business day.

On the Internet

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

You can visit us

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

Once SeniorHealth has received your grievance you will receive a letter from us telling you that SeniorHealth has 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 SeniorHealth 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. SeniorHealth must receive the completed and signed Appointment of Representation Statement before your grievance can be started. You have 60 days to file a grievance from the day the grievance occurred.

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 SeniorHealth 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 SeniorHealth you have the right to file an appeal. You can contact SeniorHealth at 1-877-661-6230 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 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

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

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

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. - 8 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 into SelectCare 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 SeniorHealth member. The SeniorHealth member information and the name of who 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 Medicare contract with the Centers for Medicare and Medicaid Services (CMS). At the end of each year, this contract is reviewed and either CCHP or CMS 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 CMS must end our contract in the middle of the year.

Whenever a Medicare contract with a health plan is terminated, members will be given a special enrollment period to choose how to get Medicare through other programs. This includes choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy.

SeniorHealth Evidence of Coverage (PDF)


H0502_12 031c CMS Approval 3/09/2012