The HMO has denied my hospital claim because I did not use a participating service provider. What are my rights, and what should I do?
Your first step is to file a written grievance with the HMO as outlined in your member booklet. The HMO is allowed 60 days from the date that a formal written grievance is filed to review it and respond to you. If the matter is not resolved after that period of time, call the Consumer Help line toll-free at 1-800-342-2762.
Related Questions
- If a provider has a claim with a date of service prior to December 17, 2007, should the provider use the Medi-Cal provider number or an NPI on the claim?
- The HMO has denied my hospital claim because I did not use a participating service provider. What are my rights, and what should I do?
- My provider billed a claim for 76075 and 76076 the same date of service, and the 76076 was denied. Why?
