Appeals and Grievance Procedures

For Group Plan Members

CCHP wants you to be satisfied with the services you receive. We want to hear from you when you have any problems or issues with the health plan. When you have a problem or a complaint, call Member Services at 415-834-2118. They can explain your health plan benefits, or, if your problem is about another matter, they will try to solve it right away. If they can't, they will help you file an appeal or grievance. CCHP will not discriminate against you because you file an appeal or grievance.

What is a Grievance or an Appeal

An appeal is a type of grievance that concerns a coverage decision. You want CCHP to change a decision either CCHP is not paying for a service you received or will not pay for a service that you feel you should have as a CCHP member.

A grievance is a written or oral complaint about CCHP and/or a provider. You may have concerns about the quality of care you receive, or issues with the quality of services the might include office waiting times, physician behavior, adequacy of facilities, or other similar concerns.

How to File

If you would like to file a verbal or written appeal or grievance, please contact the Member Services Department. The Member Services staff can help you. Your doctor can also help you. Though not required, CCHP has a complaint form you can download, or you can complete and submit an appeal and grievance form online.

Where Do I Get the Form?

There are several options:

1. Complete the secure online form and submit to us:

Secure on-line Appeals and Grievance Form

2. Print a form from this website and mail/fax/or bring it in to us:

Download Form (PDF)*.

3. You can get a complaint form at Member Services and in all CCHP providers offices.

4. You don't have to use our form to file a grievance or appeal; you may call Member Services, send us a letter or fax, or come to our office. Please provide a brief explanation of the issue and submit it in one of the following ways:

Telephone:	1-415-834-2118


TTY/TTD:	1-877-681-8888

By Fax:	1-415-397-2129

In Person:	CCHP Member Services 845 Jackson Street San Francisco, CA 94133

By Mail:	Chinese Community Health Plan Attn: Appeals and Grievances 445 Grant Avenue, Suite 700 San Francisco, CA 94108

What Happens After You File

Within 5 days after receiving your request, we will send you a letter letting you know that we received your complaint. Within 30 days after we receive your request, we will send you a written notice with CCHP's answer and the process for re-opening the case if you are not satisfied with our response.

Expedited Review

You can ask for a fast appeal if you or your doctor believe that your health could be seriously harmed by waiting too long for a decision. You must call or fax you request to Members Services. CCHP must decide on a fast appeal no later than 72 hours after we get your request. As a CCHP member, you are not required to participate in CCHP's appeal or grievance process before applying to the California Department of Managed Health Care when filing expedited reviews.

California Department of Managed Health Care

Health plans in California are regulated by a department of the state government. The paragraph below is information from this department about assistance you may be able to receive from that department.

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 415-834-2118 and use your health plan'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-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's web site www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.

*Note: To view these documents, you'll need Adobe Acrobat,
which you can download here.