A AA A

Grievance Process (also referred to as "Complaint")

What is a Grievance?

As a Care1st Health Plan Member, you have a right to file a complaint (grievance) if you have a problem with your medical care or our services. However, the complaint process is used for only certain types of problems. They include quality of care, waiting times and the customer service you receive.

How to file a Grievance, step-by-step.

Step 1

Contact us Promptly

Step 2

We will Acknowledge Receipt of Your Grievance

Step 3

We Review Your Complaint and Give You Our Answer

Medicare and the Cal MediConnect Ombuds Program can also help you with complaints:

When your complaint is about quality of care:

You can make your complaint to the Quality Improvement Organization (QIO). This can be done without or in addition to making the complaint to Care1st.

When your complaint is about disability access or about language assistance:

You can file a complaint with the Office of Civil Rights at the Department of Health and Human Services.

  1. If you have a complaint about disability access or about language assistance, Call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 (TTY 1-800-537-7697). You can also call your local Office for Civil Rights at 1-562-908-8501.
  2. You may also have rights under the Americans with Disability Act and under under ADA Amendments Act of 2008 (P.L. 110-325). You can contact the Cal MediConnect Ombuds Program for assistance (refer to contact information above).

For further information on the Grievance Process, Please refer to your Evidence of Coverage.

Care1st AdvantageOptimum Plan (HMO) and Coordinated Choice Plan (HMO)
Refer to Chapter 9, Sections 1, 2, 3, and 10 of the Evidence of Coverage

Care1st TotalDual Plan (HMO SNP)
Refer to Chapter 9, Section 1, 2, 3, 11 and 12 of the Evidence of Coverage

Aggregate Numbers

Extra Help





You may ask to obtain the aggregate numbers of the plan's grievances, appeals, and exceptions . Please contact Member Services at 1-855-905-3825 (TTY: 711)