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| California Dental Network
1971 E. 4th Street Suite 184
Santa Ana Ca, 92705
Phone: 1-877-4-DENTAL
Fax: (714) 479-0779
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If you have a complaint with the
care you have received, please fill out the grievance form
below. You can fax it to us at (714) 479-0779.
Grievance Form
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| The California Department of Manages
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 at 1-714-479-0777 or
toll-free 1-877-4-DENTAL 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 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 or 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
instigative in nature and payment disputes for emergence or urgent
medical services. The department also has a toll-free telephone number
(1-888HMO-2219) and a TDD line (1-877-688-9891) for the
hearing and speech impaired. The department's Internet Web
site http://www.hmohelp.ca.gov
has complaint forms, IMR application forms and instructions online. |
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