Landmark Healthcare

Landmark Healthplan of California, Inc.
Member Grievance Form and Instructions

Spanish Grievance Procedures and Form
Chinese Grievance Procedures and Form
Tagalog Grievance Procedures and Form

If you are not a Landmark Healthplan of California, Inc., Member and have a grievance or complaint, call Landmark's Customer Service Department at
(800) 638-4557 for directions on how to file your grievance or complaint.

***IMPORTANT***

The California Department of Managed Health Care is responsible for regulating health care service plans like Landmark. If you have a grievance against Landmark, you or your representative should first telephone Landmark at 1-800-638-4557 and use Landmark'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 Landmark, 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 Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by Landmark 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 number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing- and speech-impaired. The Department's Internet website http://www.hmohelp.ca.gov has complaint forms, IMR application forms, and instructions online.

For Landmark Healthplan of California, Inc., Members:

Important Reminder:
For electronic submission of your grievance, use only the form below from this secure web site. 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:

(916) 646-3477

(800) 638-4557

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 review of your grievance, such as service dates, names and phone number 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 sent in conjunction with a grievance filed online, please be sure to reference it in your grievance and to provide enough identification with the paper documentation to enable us to match it with your 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