Grievances and Appeals

You have a right to be heard. At CenCal Health, we want every member of CenCal CareConnect to receive high-quality care and respectful service. If you’re unhappy with any part of your care or service—or if a request was denied—you have the right to file a grievance or an appeal. Please keep copies of all correspondence and documents related to your grievance or appeal. 

File a Complaint with Medicare

In addition to filing a grievance or appeal with CenCal CareConnect, you can also submit a complaint directly to Medicare. To share concerns about your health plan, care, or services, visit medicare.gov or use the button below to file a complaint with Medicare. 

Grievances

You can file a grievance verbally or in writing with your plan at any time. The plan must respond to a standard grievance within 30 days and to an expedited grievance within 24 hours. 

You can also contact Member Services for assistance: 

Contact information: 

• Phone: Call 1-877-814-1861 (TTY: CA Relay at 711) 

• Fax: Send a fax to 1-805-621-3009 

• Mail: Mail it to 4050 Calle Real, Santa Barbara, CA 93310 

• In person: Deliver it to 4050 Calle Real, Santa Barbara, CA 93310 

Appeals

An appeal is a way to ask your D-SNP to review and change a coverage decision they made. The appeal process for D-SNPs involves several levels. If you disagree with the plan’s initial decision, you can move to the next level of appeal. You or your representative have 65 days from the date on the initial denial notice to file an appeal. 

If you believe that waiting for a standard appeal decision could seriously harm your health, you can request a fast or “expedited” appeal. 

Although forms are available, you are not required to use them. Written requests should include the following: Name of the enrollee, information identifying which denial is being appealed, and contact information for the appellant. 

Parts C & D Level 1 Appeal Adjudication Timeframes 

Each level of appeal will have specific instructions and deadlines. You can find this information in your plan materials, such as your Evidence of Coverage (EOC), by contacting your plan directly or reviewing the chart below. 

Contact CenCal CareConnect

CenCal CareConnect is your first point of contact for questions about grievances and appeals. Look for contact information on your member ID card or below: 

• Phone: Call 1-877-814-1861 (TTY: CA Relay at 711)  

• Fax: Send a fax to 1-805-621-3009 

• Mail: Mail it to 4050 Calle Real, Santa Barbara, CA 93310 

• In person: Deliver it to 4050 Calle Real, Santa Barbara, CA 93310 

Appointing a Representative

You may have someone else (like a family member, friend, or advocate) represent you during the grievance or appeal process. 
CMS Appointment of Representative Form (CMS-1696) English
CMS Appointment of Representative Form (CMS-1696) Spanish

Other Contact Information

CenCal CareConnect Member Services: Call 1-877-814-1861 (TTY: CA Relay at 711), 7 days a week, 8 a.m. to 8 p.m. PT. You can also visit www.cencalhealth.org. 

The California Department of Health Care Services (DHCS) Medi-Cal Ombudsman: Call 1-888-452-8609 (TTY: 711). The California Department of Health Care Services (DHCS) Medi-Cal Ombudsman can answer questions if you have a problem with your appeal. They can also help you understand what to do next. They aren’t connected with our plan or with any insurance company or health plan. Their services are free. 

Health Insurance Counseling and Advocacy Program (HICAP): Call 1-800-434-0222 (TTY: 711). HICAP counselors can help you with Medicare issues, including how to appeal. HICAP isn’t connected with any insurance company or health plan. Their services are free. 

Medicare: Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY users can call 1-877-486-2048). Or, visit Medicare.gov. https://www.medicare.gov/my/medicare-complaint 

California Department of Health Care Services Helpline: Call 1-800-541-5555 (TTY: 711). 

Medicare Rights Center: Call 1-800-333-4114, or visit www.medicarerights.org. 

Eldercare Locator: Call 1-800-677-1116, or visit www.eldercare.acl.gov to find help in your community. 

Materials

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