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The California Department of Managed Health Care is responsible for regulating health care service plans. The department's Health Plan Division has a toll-free telephone number (1-800-400- 0815) to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service's toll-free numbers (1-800-735-2929 (TTY) or 1-888-877-5378 (TTY) to contact the department. The department's Internet website, www.dmhc.ca.gov , has complaint forms and instructions online. If you have a grievance against your health plan, you should first telephone your plan at 1-800-932-0034 and use the plan's grievance process before contacting the Health Plan Division for assistance. The plan's grievance process and the Health Plan Division's complaint review process are in addition to any other dispute resolution procedures that may be available to you, and your failure to use these processes does not preclude your use of any other remedy provided by law.

Complaint / Grievance Process

What is a grievance? A grievance is a statement by any enrollee, family member, provider of service or member of the general public regarding any concern or problem in utilizing, or receiving program service, quality of service, logistics, materials, or any other aspect of the EAP provided to the corporate client. Complaints can range from the very minor, to the serious. All will be received, recorded, investigated and disposed of in a manner consistent with standards of clinical practice; law and regulation; common sense; and the highest standards of business integrity.

1. Grievance Log: Each grievance, whether reported on a form or orally, is recorded in the ACI Grievance Log. This record includes the date of receipt, identification of the individual recording the grievance, and the date and disposition of grievance. Other information, including a brief description of the grievance, may be a part of the record. ACI annually tabulates all information about grievances, processed and resolved, and reports to the President and CEO, QMC, and Board of Directors of ACI. All records are maintained for a minimum of five years.
2. Grievance Intake: The procedure for logging oral complaints is as follows: the Intake Specialist calls up the ACI database as the caller is speaking and enters the information onto the form that appears on the screen. At the conclusion of the call, the entry is completed, and forwarded to the Clinical Director. The Clinical Director determines the course of investigative action, initiates the investigation, and additionally refers the complaint to the QMC.
3. Forms: The complaint may be reported in any oral communication manner, phone, in person, etc. It can also be reported in any written form, or reported on the ACI forms made available to providers for distribution in their offices, mailed on request, accessible on-line at the ACI website www.ACIEAP.com , or from the corporate HR department. This can also be initiated by simply dialing 1-800-932-0034.
4. Reporting: Any person wishing to report a grievance can discuss the matter with the HR department personnel in the contracting company, any provider, any representative of the company, any broker or consultant related to the contract, or any staff member of ACI.
5. Review: A member of the Clinical Services Department will initially review the complaint. That member will perform a first level review, including an initial investigation and recommended action appropriate to dispose of the problem and satisfy the complainant. If more complex consideration is needed, the Clinical staff member will consult with the Clinical Director, the President and CEO, members of (or the body as a whole) the QMC, and/or any other resource that may appropriately provide input toward favorable outcomes.
6. Communication and Education: Enrollees are informed of the "Grievance Procedure" during orientation meetings, flyers and brochures, and online reference. The toll-free number appears on all posters, brochures and other materials.
7. Timeliness: All Grievances are responded to in writing within 10 days, acknowledging receipt of the complaint. Within thirty days, another notice will be sent out to the Subscriber notifying them of the determination by ACI. If the subscriber is not satisfied with the result, he/she may request the matter be sent to the Quality Improvement Committee for further review. These appeals must be made in writing within 45 days of the initial lodging of said grievance. Subscribers will be notified within 30 days of the Quality Improvement Committee's decision. Should this still not be a satisfactory result, subscriber should see the next section entitled "Review by the Department of Managed Care" to set up an appointment with the Department.
8. Discrimination: No discrimination is made either against the complaint or any other person involved in the complaint based on sex, disability, race, culture, religion or any other prohibited basis. No service restrictions are applied to any person filing or involved in a complaint.