Need to know
Marin County is committed to finding solutions to the issues you may face when receiving services from BHRS. As a client of BHRS, you are encouraged (but not required) to discuss issues about your services with your provider. If you remain dissatisfied with the services you receive, you have the right to file a grievance.
Grievance: Grievance means an expression of dissatisfaction about any matter other than an Adverse Benefit Determination. A member may file a Grievance at any time. Grievances can be filed verbally or in writing. You will not be discriminated against or treated unfairly for filing a grievance, appeal, or expedited appeal. Members will continue to receive services during the grievance process.
Appeal: Clients with Medi-Cal have the rights to file an appeal within 60 days of receiving an Adverse Benefits Determination if services are denied, modified, terminated, unreasonably delayed. A member, or a provider and/or an authorized representative, may request an appeal orally or in writing. Appeals filed by the provider on behalf of the member require written consent from the member.
Expedited Appeal: You or your Authorized Representative has the right to file an expedited appeal. If you or your Authorized Representative decides that a standard appeal could seriously endanger your life, health or ability to attain, maintain, or regain maximum function, an expedited appeal may be requested and granted.
Your expedited appeal will be examined and a written resolution will be provided to you or your authorized representative no later than 72 hours after receipt.
Medi-Cal members have the right to request a State hearing after appealing an Adverse Benefit Determination and receiving notice that BHRS is upholding the adverse benefit determination or if BHRS fails to adhere to the notice and timing requirements in CFR, Title 42, section 438.408, including a failure to provide a Notice of Adverse Benefit Determination or a Notice of Appeal Resolution. You must file the request within 120 calendar days of the BHRS decision.
Before you start
- Write down what happened, when it happened, and who was involved.
- Gather any letters, appointment notes, or other records you have.
- If you want a response, include your contact information.
- Talk with your provider about your concern if you feel comfortable doing so.
What to do
- Complete the grievance form below-
- Return the completed form by
- Mail it to BHRS Quality Management Unit, 20 N. San Pedro Rd., San Rafael, CA 94903.
- Hand to the receptionist at the place you received services
- Email it to BHRS Quality Management
- If you have questions or want help filing a grievance or appeal, call the Access Line at 888-818-1115.
If there is a concern of discrimination based on sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you may also file a grievance directly with the State of California's Department of Health Care Services here or with the U.S. Department of Health and Human Services here.
What's next
Get help
Access Line: 888-818-1115