Grievance Form For California Managed Care Members (Page 3 of 3) in pdf

California Managed Care Member

Health Plan Grievance Addresses

Please send your grievance letter to your health plan at:

Aetna Health of California

Attn: Commercial Grievance & Appeals, P.O. Box 10169, Van Nuys, CA. 91410

Member Services: 800-756-7039, 877-665-6736 (72 Hr. Expedited), TDD-TTY: (800) 628-3323

Fax 860-754-5321 (72 Hr. Expedited)

Blue Cross of California

Attn: Grievance & Appeal Mgt. Dept., P.O. Box 4310, Woodland Hills, CA 91365-4310

“Call Cust. Serv. at the # on the front of your ID card.” for Oral-Exp. Appeals (varies by group ID)

7 a.m. – 12 p.m., M-F, PST; 8 a.m. – 4 p.m., Sat., Fax 818-234-2767 or 3824

Blue Shield of California

Attn: Member Services, P.O. Box 272540, Chico, CA 95927-2540.

Member Services Phone: 800-424-6521, option 3, Spanish 800-424-6521

TDD-TTY: call 800-241-1823 (Oral req.), Internet website:

CIGNA HealthCare (California)

Attn: Grievance & Appeal Mgt. Dept., 400 N. Brand Blvd., Glendale, CA 91203-2311

Member Services Phone: 800-832-3211, Option 1; Member Srvs., TDD-TTY: 877-688-9891

Chinese Community Health Plan

Attn: Member Services, 170 Columbus, Suite 210, San Francisco, CA 94133

Member Services: 415-397-3190, Fax: 415-397-7077, TDD-TTY: 877-681-8888

Health Net (California)

Attn: Appeals & Grievances Dept., P.O. Box 10348, Van Nuys, CA 91410-0348

Member Services Phone: 800-522-0088; Fax: 818-676-7200; Expedited Fax 818-676-7504

TDD-TTY: Commercial – 800-995-0852; Medi-Cal – 800-952-8349

InterValley Health Plan

Attn: Health Services-Exp. Mbr. Appl., P.O. Box 6002, Pomona, CA 91769-6002

Member Services: 800-251-8191 M-F, 8 a.m. – 5 p.m., Fax 909-620-8092

TDD-TTY: 800-505-7150, Exp.

One Health Plan of California, Inc.

Attn: Medical Management, 1740 Technology Dr., #320, San Jose, CA 95110

Member Services Phone: 800-663-8081, Fax 408-437-4193, TDD-TTY: 800-735-2258

PacifiCare of California

Attn: Appeals Dept.-Exp. Mbr. Apls., P.O. Box 6006, Cypress, CA 90630

Member Services Phone: 800-624-8822, Fax 714-226-8804 Std. Appeals, TDD-TTY: 800-442-8833

Prudential HealthCare (California)

Attn: Prudential Healthcare Appeals, PO Box 45146, Jacksonville, FL 32207-5146

Member Services: 1-800-456-5510; Fax number: 904-351-4248

Universal Care

Attn: Member Services-Exp. Member Appeals, 1600 E. Hill St., Signal Hill, CA 90806-0548

Member Services Phone: 800-635-6668, Fax: 562-981-5822, TDD-TTY: 866-321-5955

Western Health Advantage

Attn: Member Services, 1331 Garden Highway, Ste 100, Sacramento, CA 95833

Member Services: 888-563-2250, Fax 916-568-0126, TDD-TTY: 888-877-5378

Page 3 of 3

Grievance Form For California Managed Care Members Page 3

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