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Grievances & Appeals

 

How to Express a Concern or Dissatisfaction
with Care or Service

 

As a participant of the On Lok Lifeways PACE program, it is your right to voice your concerns and file a complaint at any time, without fear of reprisal from staff.

In order to better serve you, we have grouped concerns and dissatisfaction into two categories:

Grievances

The On Lok Lifeways PACE program considers a “grievance” as any complaint, either written or oral, that expresses dissatisfaction with how we deliver our services or the quality of care that we provide. For information about how to file a grievance, please read the On Lok Lifeways Information for Participants about the Grievance Process in your preferred language below.

English | Chinese | Spanish | Vietnamese

Appeals

When the On Lok Lifeways PACE program decides not to cover or pay for a service you want, you may take action to change our decision. The action you take—whether verbally or in writing—is called an “appeal”. For information about how to file an appeal, please read the On Lok Lifeways Information for Participants about the Appeals Process in your preferred language below.

English | Chinese | Spanish | Vietnamese

 

There are several ways to file a grievance or an appeal. You can complete one of the following options:

Submit a grievance or an appeal using our online form

Our Online Grievance and Appeals Form is available in multiple languages as listed below. To access our online form, please click the button below.

Submit a grievance or an appeal in person or by mail

You can print and complete a grievance or appeals form and deliver it in person or by mail to the Health Plan Associate.

Health Plan Associate
On Lok Lifeways
1333 Bush Street
San Francisco, CA 94109

To access our grievance or appeals form, please select your preferred language below.

Grievances

English | Chinese | Spanish | Vietnamese

Appeals

English | Chinese | Spanish | Vietnamese

Submit a grievance or an appeal by telephone or email

You can call or e-mail the Health Plan Associate to submit a grievance or an appeal.

Telephone: 415-292-8895
Toll-Free: 1-888-996-6565
For the Hearing Impaired: TTY 415-292-8898
San Francisco, CA 94109
Email: memberservices@onlok.org

After you submit a grievance or an appeal, our Health Plan Associate will contact you for further information. You can contact our Health Plan Associate at 415-292-8895 or 1-888-996-6565. For the hearing impaired, please call our TTY number, 415-292-8898.

For more information about the Grievance and
Appeals process, you can also contact:

California Department of Managed Health Care
California Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725

Telephone: 1-888-466-2219
TDD: 1-877-688-9891
Website: http://www.hmohelp.ca.gov

Provider Dispute Resolution Information

Occasionally, providers may want to notify On Lok of a concern regarding the administration or operation of the plan. Other times, contractual or payment disputes may occur that require some form of resolution. For all information on how providers can voice a concern, please click here.