If you have a problem with MediExcel Health Plan
MediExcel Health Plan is committed to meeting the needs of our members. Our Member Services staff is available to answer questions and help you get the health care you need. If you have a problem with MediExcel Health Plan, you have the right to file a complaint. A complaint is also called a grievance or an appeal.
Here are some examples of when you can file a complaint with MediExcel Health Plan:
• You have been denied a service, treatment, or medicine.
• You have been denied a referral.
• MediExcel Health Plan cancels your health benefits.
• MediExcel Health Plan does not reimburse you for a covered service that you paid for and received.
• MediExcel Health Plan does not pay for emergency room care you needed.
• You cannot get an appointment as soon as you need it.
• You think you received poor care or service.
First, file your complaint with MediExcel Health Plan Member Services
• If your problem is urgent MediExcel Health Plan must give you a decision within 3 days. An urgent problem is an immediate and serious threat to your health.
• If your problem is not urgent, MediExcel Health Plan must give you a decision within 30 days.
• You must file your complaint within 6 months after the incident or action that is the cause of your problem with MediExcel Health Plan.
California law requires that we include the following statements:
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, in the US, call Toll Free (855) 633-4392. In Baja California, México, call (664) 633-83-00, 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 Internet Web site has complaint forms, IMR application forms and instructions online.
If you have a grievance, please add one or more of the following to the Subject case on the form below:
Grievance Expedited Processing (Pain or immediate danger to patient's health)
Complaint about access to care (including complaints about waiting time for appointments)
Dispute involving medical necessity
Complaint about experimental/investigational treatment
Complaint about the quality of care
Compaint about quality of service
Other issue (s)