A complaint (or grievance) is when you have a problem or are unhappy with the services you are getting from L.A. Care or a provider.
There is no time limit to file a complaint. You can file a complaint with L.A. Care at any time by phone, in writing or online.
- Online:
You can submit an online Grievance Form. - By Phone:
Call L.A. Care Member Services at 1-888-839-9909 (TTY: 711) 24 hours a day 7 days a week including holidays. Give your health plan ID number, your name and the reason for your complaint. - By Mail:
Call L.A. Care at 1-888-839-9909 (TTY: 711) and ask to have a form sent to you.
When you get the form, fill it out. Be sure to include your name, health plan ID number and the reason for your complaint. Tell us what happened and how we can help you.
Mail the form to:
L.A. Care Health Plan
Appeal and Grievance Department
1200 West 7th Street
Los Angeles, CA 90017
Your doctor’s office will also have complaint forms available.
If you need help filing your complaint, we can help you. We can give you no-cost language services. Call L.A. Care Member Services at 1-888-839-9909 (TTY: 711).
Within 5 calendar days of getting your complaint, we will send you a letter telling you we got it.
Within 30 days, we will send you another letter that tells you how we resolved your problem.
If you call L.A. Care about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next business day, you may not get a letter.
If you have an urgent matter involving a serious health concern, we will start an expedited (fast) review. We will give you a decision within 72 hours. To ask for an expedited review, call us at Member Services at 1-888-839-9909 (TTY: 711).
Within 72 hours of getting your complaint, we will decide how we will handle your complaint and whether we will expedite it. If we find that we will not expedite your complaint, we will tell you that we will resolve your complaint within 30 days. You may contact DMHC directly for any reason, including if you believe your concern qualifies for expedited review, or L.A. Care does not respond to you within the 72-hour period.
Complaints related to Medi-Cal Rx pharmacy benefits are not subject to the L.A. Care grievance process or eligible for Independent Medical Review. Members can submit complaints about Medi-Cal Rx pharmacy benefits by calling 1-800-977-2273 (TTY 800-977-2273 and press 5 or 711) or visiting the Medi-Cal Rx website.Complaints related to pharmacy benefits not subject to Medi-Cal Rx may be eligible for an Independent Medical Review.
You can find the Independent Medical Review / Complaint form and instructions online at the DMHC’s website. You can also call DMHC’s toll-free telephone number at 1-888-466-2219 (TTY 1-877-688-9891).