Problem Resolution


Behavioral Health Services are monitored by a committee comprised of system-wide partners, consumers, consumer liaisons, family members, advisory board members, and County staff to ensure the highest quality services.  Behavioral Health Services encourages the resolution of problems at the least formal level possible.  No person will be subject to any penalty or discrimination for filing a complaint or grievance or for requesting a State Fair Hearing.  A person may authorize a representative of their choice to act on his/her behalf at any time. 

Please click on a link below for our Problem Resolution Guide


Problem Resolution Guide - Chinese 
Problem Resolution Guide - English
Problem Resolution Guide - Hmong
Problem Resolution Guide - Russian
Problem Resolution Guide - Spanish
Problem Resolution Guide - Vietnamese 

Grievance

Grievance is an expression of dissatisfaction about any matter other than an Action.

  • The member may submit a grievance orally or in writing to Member Services.
  • The member will receive a written resolution within 60 days. 

Please click on a link below for a grievance form

Grievance Form - Chinese
Grievance Form - English
Grievance Form - Hmong
Grievance Form - Russian
Grievance Form - Spanish
Grievance Form - Vietnamese

Standard Appeal

An Appeal is a request to review an Action.  An Action occurs when previously authorized services are denied, reduced, suspended or terminated; when payment is denied for a service; when services are not provided in aa timely manner; or the County fails to act within the timeframes for the disposition of grievances, standard appeals, or expedited appeals.

  • The member may submit an appeal orally or in writing.  Oral appeals must be followed up with a written, signed appeal.
  • An appeal must be filed within 90 days of the date of the Action.
  • The member will receive a written resolution within 45 days.

Expedited Appeal

This Appeal is filed when the member’s life, health, or ability to have or maintain maximum function is at risk.

  • The member will receive a written resolution within 3 working days.
  • If the expedited appeal is denied, a written notice will be sent to the member and the standard appeal process will begin. 

Please click on a link below for a Standard/Expedited Appeal form


Appeal Form - Chinese
Appeal Form - English
Appeal Form - Hmong
Appeal Form - Russian
Appeal Form - Spanish
Appeal Form - Vietnamese

State Fair Hearing

If you are a Medi-Cal beneficiary, you have the right to file for a State Fair Hearing. The member must exhaust the problem resolution Appeal process prior to filing for a State Fair Hearing. The concerns within the jurisdiction of the Administrative Law Judge are those related to an Action.

Note: Grievance forms, Standard Appeal forms, or Expedited Appeal forms are also available at all provider sites or can be obtained by contacting Member Services at (916) 875-6069.

The member will be notified in writing that Member Services received his/her grievance or appeal.

The member may submit additional information to support a claim either in writing or in person.  For the convenience of the beneficiary, scheduling an appointment with Member Services is highly recommended.

The member may receive assistance in filing a grievance, appeal, or a State Fair Hearing from: 

Member Services

Phone: (916) 875-6069
TTY/TDD: (916) 876-8853
Monday – Friday, 8 a.m. – 5 p.m.
Email: QMInformation@saccounty.net

or

Patient Rights Advocate

Phone: (916) 333-3800



 
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