Grievances and Appeals

 

Appeals & Grievance Contact Information
For questions about the appeals and grievance process or the status of an open appeal or grievance, please call: 1-866-634-2247(TTY: 711).

Calls to this number are free, 8 a.m. to 8 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30. Member Services also has free language interpreter services available for non-English speakers.

Data Regarding Appeals & Grievances
Any Alignment Health Plan member may at any time during their enrollment, request grievance and appeal data orally or in writing by contacting the Member Services Department.

Write: Alignment Health Plan
c/o Member Services Department
1100 W. Town & Country Road, Suite # 300
Orange, CA 92868

Call: 1-866-634-2247 (TTY: 711)

The process for coverage decisions and appeals can be found in Chapter 9 of your evidence of coverage (EOC). This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Please refer to Chapter 9 of your EOC for a full description of the process.
Evidence of Coverage

You can also access this information by downloading Chapter 9 here.
2019 English or 2019 Spanish

Download this form to file a formal complaint or appeal regarding any aspect of the medical care or service provided to you. Your complaint or appeal may be in reference to your medical or pharmaceutical benefits.

Grievance and Appeals Form- English
Grievance and Appeals Form- Spanish

You may also submit feedback or complaints about your Medicare Advantage Health Plan directly to Medicare by submitting a compliant through www.medicare.gov or by calling 1-800-Medicare.