Grievance & Appeals

GRIEVANCE AND APPEAL

There are two kinds of problems that you may have with AHP:

  • A grievance is when you have a problem with AHP or a provider, or with the health care or treatment you got from a provider.
  • An appeal is when you don’t agree with AHP’s decision not to cover or change your services.

You have the right to file grievances and appeals with AHP to let us know about your problem. This does not take away any of your legal rights and remedies. We will not discriminate or retaliate against you for complaining to us. Letting us know about your problem will help us improve care for all members.

You should always contact AHP first to let us know about your problem. Call us between Monday through Friday from 9 a.m. to 5:30 p.m. (excluding holidays) at customer service at 1-800-633-3313 (TTY: 711). Tell us about your problem.

HOW TO FILE A GRIEVANCE

If you believe that AHP has failed to provide these services or unlawfully discriminated in another way on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity or sexual orientation, you can file a grievance with AHP’s Grievance and Appeals Department. You can file a grievance in writing, in person, or electronically:

  • By phone: Contact between Monday through Friday from 9 a.m. to 5:30 p.m. (excluding holidays) by calling 1-800-633-3313. Or, if you cannot hear or speak well, please call (TTY: 711) to use the California Relay Service.
  • In writing: Fill out a Member Grievance and Appeals Form or write a letter and send it to:
  • AmericasHealth Plan
    Grievance and Appeals Department
    1000 Town Center Drive Suite 410
    Oxnard, CA 93036

    Download Member Grievance and Appeals Form

  • In person: Visit your doctor’s office or AHP and say you want to file a grievance.
  • Electronically: Visit AHP’s website at www.americashp.com.

OFFICE OF CIVIL RIGHTS – CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
You can also file a civil rights complaint with the California Department of Health Care Services, Office of Civil Rights by phone, in writing, or electronically:

  • By phone: Call 916-440-7370. If you cannot speak or hear well, please call TTY: 711 (Telecommunications Relay Service).
  • In writing: Fill out a complaint form or send a letter to:

Deputy Director, Office of Civil Rights Department of Health Care Services
Office of Civil Rights
P.O. Box 997413, MS 0009
Sacramento, CA 95899-7413

Complaint forms are available at www.dhcs.ca.gov/Pages/Language_Access.aspx .

OFFICE OF CIVIL RIGHTS – U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

If you believe you have been discriminated against on the basis of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by phone, in writing or electronically:

  • By phone: Call 1-800-368-1019. If you cannot speak or hear well, please call TTY/TDD 1-800-537-7697 or 711 to use the California Relay Service.
  • In writing: Fill out a complaint form or send a letter to:

U.S. Department of Health and Human Services 200 Independence Avenue,
SW Room 509F, HHH Building
Washington, D.C. 20201

Complaint forms are available at www.hhs.gov/ocr/office/file/index.

 

HOW TO FILE AN APPEAL

An appeal is a request for AHP to review and change a decision we made about coverage for a requested service. If we sent you a Notice of Action (NOA) letter telling you that we are denying, delaying, changing or ending a service, and you do not agree with our decision, you can file an appeal. Your PCP or other provider can also file an appeal for you with your written permission.

You must file an appeal within 60 calendar days from the date on the NOA you got from AHP. If you are currently getting treatment and you want to continue getting treatment, then you must ask AHP for an appeal within 10 calendar days from the date the NOA was delivered to you, or before the date AHP says services will stop. When you request an appeal under these circumstances, treatment will continue upon your request. We may require you to pay for the cost of services if the final decision denies or changes a service.

You can file an appeal by phone, in writing or online:

  • By phone: Contact between Monday through Friday from 9 a.m. to 5:30 p.m. (excluding holidays) by calling 1-800-633-3313. Or, if you cannot hear or speak well, please call (TTY: 711) to use the California Relay Service.
  • In writing: Fill out a Member Grievance and Appeals Form or write a letter and send it to:

AmericasHealth Plan
Grievance and Appeals Department
1000 Town Center Drive Suite 410
Oxnard, CA 93036

Download Member Grievance and Appeals Form

  • In person: Visit your doctor’s office or AHP and say you want to file a grievance.
  • Electronically: Visit AHP’s website at www.americashp.com.

If you need help filing your appeal, we can help you. We can give you free language services. Call customer service at 1-800-633-3313 (TTY: 711). AHP is here Monday through Friday from 9 a.m. to 5:30 p.m. The call is toll free.