Appeals and Grievance Procedures

For CCHP Senior Select Program 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.

If you need assistance with these procedures, you can have someone act as your appointed representative. If you name an appointed representative, both you and that person must sign and date a statement that gives the person legal permission to act as your appointed representative. Click here to download an appointment of representative form. If you need help completing the form, please call Member Services.

Drug Benefit Appeals and Grievances

There are separate procedures for filing an appeal or grievance that involves your Medicare Part D drug benefits. Please select the following for details:

What is a Grievance or an Appeal

An appeal is the type of complaint you make when you want us to reconsider and change a decision we have made about what services are covered for you or what we will pay for a service. For example, if we refuse to cover or pay for services or benefits you think we should cover, you can file an appeal. If CCHP or one of our Plan providers refuses to give you a service you think should be covered, you can file an appeal. If CCHP or one of our Plan providers reduces or cuts back on services or benefits you have been receiving, you can file an appeal. If you think we are stopping your coverage of a service or benefit too soon, you can file an appeal.

A grievance is the type of complaint you make if you have any other type of problem with CCHP or one of our Plan providers. For example, you would file a grievance if you have a problem with things such as the quality of your care, waiting times for appointments or in the waiting room, the way your doctors or others behave, being able to reach someone by phone or get the information you need, or the cleanliness or condition of the doctor's office.

How to File

If you would like to file an appeal or grievance, please contact the Member Services Department for assistance. The Member Services staff can help you to file an appeal or grievance. Your doctor can also help you. You must file an appeal in writing. You may submit a grievance orally or in writing. 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:

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

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 next steps in the process if you are not satisfied with our response.

Expedited Review

You can ask for a fast appeal or grievance if you or your doctor believes that waiting too long for a decision could seriously harm your health. You must call or fax you request to Members Services. CCHP must decide on a fast appeal or grievance no later than 72 hours after we get your request.

Complete Details

For more detail about the appeal and grievance procedures, please read Sections 10, 11 and 12 of your CCHP Evidence of Coverage.

For our Members with Medicare:
CCHP Senior Program Evidence of Coverage (PDF)

For our Members with both Medi-Cal and Medicare:
CCHP Senior Select Program Evidence of Coverage (PDF)

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

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