Member Handbook - Los Angeles County Department of Health ...

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Medi-Cal Member Handbook / Benefit Year 2006-2007State Fair HearingA State Fair Hearing is another way you can file agrievance. You can present your case directly tothe State of California. All L.A. Care/CommunityHealth Plan members have the right to ask for aState Fair Hearing at any time within 90 days ofthe incident. You may still request a State FairHearing if you request an IMR. However, youwill not be able to use the IMR process if youhave requested a State Fair Hearing. Go to the“IMR” section to find out more.You may ask for a State Fair Hearing by callingtoll-free 1-800-952-5253 (English and Spanish),or by writing to:California Department of Social ServicesState Hearings DivisionP.O. Box 944243, MS 19-37Sacramento, CA 94244-2430Expedited State HearingIn cases of health services denials, you or yourprovider may ask for a faster decision through anExpedited State Hearing if your life, or health, orability to attain, maintain or regain maximumfunction could be seriously risked by goingthrough a standard State Fair Hearing. An emancipatedminor, a parent on behalf of his/her minorchild, and a duly-appointed guardian or conservatorof a member may also request an ExpeditedState Hearing. Requests for Expedited StateHearings should be directed to:Expedited Hearings UnitCalifornia Department of Social ServicesState Hearings Division744 P Street, MS 19-65Sacramento, CA 95814Fax: 916-229-4267You can also call the DPSS Los Angeles Countyoffice toll-free at 1-877-481-1044. If you do notspeak English, please stay on the line and ask forthe language you speak. DPSS has staff whospeaks Armenian, Chinese, Russian, Spanish,Tagalog and Vietnamese. You may also write to:Department of Public Social Services(DPSS)State Fair Hearings SectionP.O. Box 10280Glendale, CA 91209Ombudsman OfficeYou may call the Ombudsman Office of theCalifornia Department of Health Services (CDHS)for help with grievances. The Ombudsman Officewas created to empower Medi-Cal beneficiariesto fully use their rights and responsibilities as amember of a managed care plan. To find outmore, call toll-free 1-888-452-8609.Arbitration:Solving problems without going to court.L.A. Care knows that some members wish to gethealth care services from a health plan that usesarbitration. When you choose arbitration, yougive up the right to have your problem settled bya judge or jury. Many view arbitration as cheaper,quicker and better than the courts.During arbitration, a neutral (unbiased) arbitratorwill listen to everyone and make a decision. Youand your doctor or health plan must follow thatdecision. That is why the process is often called“binding” arbitration.The party that does not win will pay for the costsunless the arbitrator decides otherwise. Thatbeing said, the winning party will never beresponsible for more than legal fees and costs ormore than one-half of the costs.33Community Health Plan Member Services Department toll-free 1-800-475-5550L.A. Care Health Plan Member Services Department toll-free 1-888-4LA-Care or 1-888-452-2273
Medi-Cal Member Handbook / Benefit Year 2006-2007L.A. Care or Community Health Plan, if theyoffer arbitration, may pay some or all of the feesand expenses of the arbitrator in cases of greatfinancial hardship. Please contact L.A. Care orCommunity Health Plan for information and anapplication. Arbitration does not apply to claims,disputes or controversies about alleged medicalmalpractice.34Community Health Plan Member Services Department toll-free 1-800-475-5550L.A. Care Health Plan Member Services Department toll-free 1-888-4LA-Care or 1-888-452-2273
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Member Handbook - Los Angeles County Department of Health ...

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