We want to know about any problems you may have in getting health care services. You may submit your grievance on-line, by telephone, in person or in writing and mail to the following address:

Community Health Plan Grievance Coordinator 1000 South Fremont Avenue Building A-9 East, 2nd Floor, Unit #4 Alhambra, California 91803-8859 1 (855) 830-9222 TDD Service: 1 (800) 353-7988

Prior to completing your grievance submission online, you will need to have available your Community Health Plan ID card. You may enter your information directly into the fields provided on the attached form. Upon completion, print a copy of the form for your records.

WHAT DO YOU NEED TO DO?

STEP 1: Complete the Member Information at the top portion of the form. This is information pertaining to the member only. Include the sequence of events and how the problem affected you.

STEP 2: After you have filled out the form, please take a moment to review the information prior to your submission.

STEP 3: After the Community Health Plan has received your grievance, you will receive a letter within 5 days informing you that Community Health Plan has received your grievance. The letter will include a contact person who you may call for information.

Community Health Plan will review your grievance and work to resolve your problem. Community Health Plan will send you a letter of the grievance resolution or appeal within 30 calendar days from the day your grievance was received. The letter will include information on how to file an appeal with Community Health Plan.