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<br />.s. / c? - J,G, <br /> <br />Complaints and Grievances <br /> <br />As a condition of enrollment and a contractual tenn of the Agreement and this Evidence of Coverage, <br />Members are required to submit all grievances through MHN's grievance procedures. MHN's <br />grievance procedures, as specified below, must be completed before the Member may file for any <br />legal action or arbitration to receive a final and binding resolution of the grievance. <br /> <br />Please note: After participating in MHN's grievance and/or appeals process for a period of thirty (30) <br />days (or three days for emergency grievances), the Member has the right to file a request for <br />assistance with the Department of Managed Health Care (the "Department"). When MHN has notice <br />of a case involving imminent and serious threat to the health of the patient, including, but not limited <br />to, severe pain, potential loss of life, limb or major bodily function, MHN provides the following: (a) <br />immediate notification to the Member of their right to notify the Department of the grievance, and (b) <br />no later than three days from receipt of the notice of such grievance request, a written statement to the <br />Member and the Department on the disposition or pending status of the grievance. See Section <br />entitled "The Department of Managed Health Care." <br /> <br />Grievance Process <br /> <br />1, Grievances may be filed with any MHN staff member in writing, on-line at www.mhn.com, or by <br />,calling MHN. You may call MHN at 1-800-227-1060, or write to: <br />MHN Quality Management Department <br />1600,Los Gamos Drive, Suite 300 <br />San Rafael, CA 94903-1807 <br /> <br />Î Grievances involving quality of care are investigated and resolved by MHN Quality Management <br />staff. <br /> <br />3, All written g1ievances are acknowledged by the Quality Management department in writing <br />within five (5) working days ofMHN's receipt of the grievance, <br /> <br />4. All grievances are resolved within thirty (30) days of MHN's receipt of the grievance, unless the <br />Member is notified within thirty (30) days that additional time is required and the reason for the <br />delay is documented. <br /> <br />" Members are notified in writing of the resolution of the grievance, <br /> <br />6, For grievances where resolution infonnation can be given, if the Member is dissatisfied with the <br />outcome of the grievance, he/she can appeal by writing to: <br />MHN <br />Quality Management Department <br />1600 Los Gamos Drive, Suite 300 <br />San Rafael, CA 94903-1807 <br /> <br />9 <br />