There are four (4) ways to file a grievance:

1. Call us:
   Alameda Alliance Wellness Member Services Department
   Seven (7) days a week, 8 am – 8 pm
   Toll-Free: 1.888.88A.DSNP (1.888.882.3767)
   If you cannot hear or speak well, use TTY or call 1.800.735.2929

2. In-Person by visiting our office:
   Alameda Alliance for Health
   1240 South Loop Road
   Alameda, CA 94502
   Hours of Operation: Monday – Friday, 8 am – 5 pm
   Lobby Hours: Tuesday, Wednesday, and Thursday, 9 am – 11 am and 2 pm – 4 pm

3. Write a letter describing the problem and mail it to the Alliance.
   Attn: Grievances and Appeals
   Alameda Alliance Wellness
   1240 South Loop Road, Alameda, CA 94502

4. Download and complete the Grievance form in your preferred language:
   English| Spanish | Chinese | Vietnamese | Tagalog | Farsi

Click here to access the online Grievance form.

Alameda Alliance Wellness Members can submit a grievance directly to the Centers for Medicare & Medicaid Services  (CMS) at https://medicare.gov/my/medicare-complaint.

Urgent Grievance or Appeal
If you think that waiting 30 days will harm your health, be sure to say why when you file your grievance or appeal. You may then be able to get an answer within 72 hours if the complaint is an immediate and serious threat to your health.

For Alameda Alliance Wellness members, Expedited Grievances will be resolved within 24 hours. Please note that grievances are only accepted as Expedited for two (2) reasons: when the grievance is regarding our decision to take an extension or when the grievance is regarding our decision to downgrade an appeal.

The Alliance will always treat you with respect. You have the right to give the Alliance your views, or provide documents that support your views, or propose a solution. You may speak for yourself or have someone else speak for you, including a lawyer. Using the grievance and appeals process does not rule out any potential legal rights or remedies that you may have.

You may ask to look at or get a copy of our records that relate to your case. You or your provider may get a copy of the benefit provision, guideline protocol, or criteria used to make a denial decision. You will receive these copies at no cost.

To request a copy, please call:
Alameda Alliance Wellness Member Services Department
Seven (7) days a week, 8 am – 8 pm
Toll-Free: 1.888.88A.DSNP (1.888.882.3767)
If you cannot hear or speak well, use TTY or call 1.800.735.2929

Appeals
When you file your appeal, you can continue to receive services until the process is complete. The Alliance must give you a decision within 30 calendar days or within 72 hours if your problem is an immediate and serious threat to your health. For Alameda Alliance Wellness member Standard Part B and D appeals, the Alliance must give you a decision within 7 days. If the Alliance denied your treatment because it was experimental or investigational, you do not have to take part in the Alliance’s appeal process before you apply for an Independent Medical Review (IMR). You must ask for the IMR within six (6) months after the Alliance sends you a written response to your appeal.

Appeal Process
If we make a coverage decision and you aren’t satisfied with this decision, you can “appeal” the decision. An appeal is a formal way of asking us to review and change a coverage decision we made.

Medical Appeal
You may have received a Notice of Action (NOA) from the Alliance. Members have 65 days from the date on the NOA to file an appeal with the Alliance.

Prescription Drug Appeal
You have the right to ask us for a redetermination (appeal) of our decision. Use the Request for Redetermination of Medicare Prescription Drug Denial form to appeal this decision.

Download and complete the Redetermination of Medicare Prescription Drug Denial form in your preferred language.
English |Spanish | Chinese | Vietnamese | Tagalog | Farsi

Here are some other ways to file a complaint:

• Contact the California Department of Managed Health Care (DMHC)
• Apply for an Independent Medical Review (IMR)
• If you suspect fraud and wish to file a complaint with the Department of Health Care Services (DHCS) State Fraud Hotline, please call toll-free at 1.800.822.6222. This hotline has a recorded message that may be heard in 10 different languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean, and Russian. You have the option to remain anonymous. You can also visit the DHCS website.
• If you suspect fraud or elder abuse, please call the California Bureau of Medi-Cal Fraud & Elder Abuse (BMFEA) toll-free at 1.800.722.0432. You can also visit the

If you need somebody to explain any part of the complaint or grievance process, please call:
Alameda Alliance Wellness Member Services Department
Seven (7) days a week, 8 am – 8 pm
Toll-Free: 1.888.88A.DSNP (1.888.882.3767)
If you cannot hear or speak well, use TTY or call 1.800.735.2929

The California Department of Managed Health Care (DMHC)
The California Department of Managed 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 1-510-747-4567 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 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 for 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 investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website   has complaint forms, IMR application forms and instructions online.

Independent Medical Review (IMR)
An Independent Medical Review (IMR) is a review of your case by doctors who are not part of the Alliance. You can ask for an IMR from the Department of Managed Health Care (DMHC). In most cases, you must complete the Alliance appeal process before you apply for an IMR with DMHC. However, if the Alliance initially denied your treatment because it was experimental or investigational, you do not have to take part in the Alliance appeal process before you apply for an IMR. You must ask for the IMR within 6 months after the Alliance sends you a written response to your appeal. If the IMR is decided in your favor, the Alliance must give you the service or treatment you asked for. There is no cost for this process.

You can apply for an IMR if the Alliance:

• Denies, changes, or delays a service or treatment because it was determined as not medically necessary.
• Will not cover an experimental or investigational treatment for a serious medical condition.
• Will not pay for emergency or urgent medical services that you have already received.

To request an IMR, please contact:

Department of Managed Health Care
Toll-Free: 1.888.466.2219
If you cannot hear or speak well (TDD): 1.877.688.9891
California Relay Service (CRS): 1.800.735.2929

For more information, or to view and download forms, please visit the DMHC https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx website.

Sometimes it’s confusing to start or follow the process for dealing with a problem. This can be especially true if you don’t feel well or have limited energy. Other times, you may not have the information you need to take the next step.

Help from the Health Insurance Counseling and Advocacy Program
You can call the Health Insurance Counseling and Advocacy Program (HICAP). HICAP counselors can answer your questions and help you understand what to do about your problem. HICAP isn’t connected with us or with any insurance company or health plan. HICAP has trained counselors in every county, and services are free. Please call HICAP toll-free at 1.800.434.0222.

Help from the Medicare Medi-Cal Ombudsman Program
You can call the Medicare Medi-Cal Ombudsman Program and speak with an advocate about your health coverage questions. They may be able to offer free legal help. The Ombudsman Program isn’t connected with us or with any insurance company or health plan. For more help, please call toll-free at 1.855.501.3077 or visit www.healthconsumer.org.

Help and information from Medicare
For more information and help, you can contact Medicare. Here are two ways to get help from Medicare:

• Call toll-free at 1.800.MEDICARE (1.800.633.4227). TTY users call 1.877.486.2048.
• Visit the Medicare website (www.medicare.gov).
• Claims, Appeals, and Complaints | Medicare

Help from the California Department of Health Care Services
The California Department of Health Care Services (DHCS) Medi-Cal Managed Care Ombudsman can help. They can help if you have problems joining, changing, or leaving a health plan. They can also help if you moved and are having trouble getting your Medi-Cal transferred to your new county. You can call the Ombudsman Monday – Friday, 8 am – 5 pm, toll-free at 1.888.452.8609.

Help from the California Department of Managed Health Care
Contact the California Department of Managed Health Care (DMHC) for free help. The DMHC is responsible for overseeing health plans. The DMHC helps people with appeals about Medi-Cal services or billing problems. Call toll-free at 1.888.466.2219. Individuals who are deaf, hard of hearing, or speech-impaired can use the toll-free TDD number, 1.877.688.9891. You can also visit DMHC’s website at www.dmhc.ca.gov.

The California Department of Managed 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 1-888-88A-DSNP (1-888-882-3767) 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 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 for 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 investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website  has complaint forms, IMR application forms and instructions online.

Fill out the IMR/Complaint Form available at: www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx

Submit the IMR/Complaint Form and any attachments to the DMHC

Submit online: https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx 
Submit by mail or fax:
Attn: Help Center
Department of Managed Health Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Fax: 1.916.255.5241

Get Help and Information from C2C Innovative Solutions Inc (C2C)
Our state has an organization called C2C Innovative Solutions, Inc –QIC Part C. This is a group of doctors and other health care professionals who help improve the quality of care for people with Medicare. C2C is not connected with our plan.

• Toll-Free: 866.320.0963
• Fax: 904.539.4080
• Mail:
  • United States Postal Service (USPS)
    Attn: QIC Part C – New Plan Dismissal Appeal
    C2C Innovative Solutions, Inc. – QIC Part C
    PO Box 1949 9
    Jacksonville, FL 32231-0053
  • UPS / FedEx Only
    Attn: QIC Part C – New Plan Dismissal Appeal
    C2C Innovative Solutions, Inc. – QIC Part C
    301 W. Bay St., Suite 1110
    Jacksonville, FL 32202

How to obtain an aggregate number of grievances, appeals, and exceptions filed with Alameda Alliance Wellness?

Please call:
Alameda Alliance Wellness Member Services Department
Seven (7) days a week, 8 am – 8 pm
Toll-Free: 1.888.88A.DSNP (1.888.882.3767)
If you cannot hear or speak well, use TTY or call 711/1.800.735.2929