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Landmark Healthplan of California Member Grievance Form and Instructions

***IMPORTANT***

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 (800) 298-4875 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 has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department's internet Web site http://www.hmohelp.ca.gov/ has complaint forms, IMR application forms, and instructions online.

For Landmark Healthplan of California Members: Important Reminder

For electronic submission of your grievance, use only the form below from this secure website. For confidentiality purposes, do not send grievance information by e-mail.

Read the Online Grievance Form Instructions below and then answer the questions, mark the appropriate check boxes, and follow the prompts to edit and send your grievance to Landmark.

Online Grievance Form Instructions

You may initiate the grievance process at any time by using the online grievance form below. If you prefer to submit a grievance in person, by telephone, or in writing, contact Landmark at:

Landmark Healthplan of California Inc.
ATTN: Quality Management Department
1610 Arden Way, Suite 280
Sacramento, California 95815

(800) 298-4875
TDD/TTY (888) 565-4236

For confidentiality purposes, do not send grievance information by e-mail.

Include all appropriate information you would like considered during the review of your grievance, such as treatment dates, names and phone numbers of people referenced in your grievance, or of people you may have spoken with regarding your grievance. Paper documentation may be mailed to the address above; if such documentation is mailed in conjunction with a grievance filed online, please be sure to reference it in your online grievance and to provide enough identification with the paper documentation to enable us to match it with your online grievance.

You will receive an acknowledgment letter by U.S. mail within five (5) calendar days of Landmark's receiving your grievance.

Landmark will review your complaint and inform you of our decision in writing through the U.S. mail within thirty (30) days.

If your case involves an imminent and serious threat to your health, including but not limited to severe pain, the potential loss of life, limb, or major bodily function, we will expedite the process as an urgent grievance within three (3) days from receipt of your request.

Continue to Online Grievance Form