Appeal or Grievance Form
Many issues or concerns can be promptly resolved by our Member Services Department. If you have not already done so, you may want to first contact Member Services before submitting one of the forms below.
Health Net of CA encourages you to provide a detailed account of your experience. Your feedback is important to us and we appreciate the time you have taken to share this information.
If you believe a delay in the decision making may impose an imminent and serious threat to your health, please contact customer service at 1-800-926-4178 TTY 711
**If you prefer to file a grievance by mail or fax, or if you need to complete the form in another language other than English, download the Grievance Form (PDF) in English or Spanish.
What should I do?
File an Appeal when appealing the denial of a service or benefit
File a Grievance to formally express your dissatisfaction with care or service(s) you have received