Grievances Form for California Residents

 

Please complete the form for any comments or concerns relating to your America's Best Vision Plan, its services, personnel, offices or any other aspect of the Plan that affects you as an enrollee.

Contact Information

You may submit your comments by clicking the "Submit" button. America's Best Vision Plan will acknowledge receipt of this comment by sending a written notified of receipt to you within five days of our receipt of this comment. If you need assistance or have questions regarding the comments process, please call America's Best Vision Plan at 1-800-841-2790. The hearing and speech impaired may use the California Relay Servi'ce toll-free number (1-800-735-2929) (TTY) to contact America's Best Vision Plan.

IMPORTANT: You can get an interpreter at no cost to talk to your doctor or health plan. To get an interpreter or to ask about written information (in your language), first call your health plan’s phone number at 1-800-841-2790. Someone who speaks your language can help you. If you need more help, call the HMO Help Center at 1-888-466-2219.

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 1-800-841-2790 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 care plan or a grievance that 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 treatment that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-800-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 on-line.

America's Best Vision Plan 
Attn: Grievance Administrator

1202 Monte Vista Avenue, Suite 17 - Upland, CA 91786

Language Assistance Disclosures