File a Grievance

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 800-321-2843 and use your health plan's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's Internet Web site http://www.dmhc.ca.gov has complaint forms, IMR application forms and instructions online.

The Holman Group Grievance Form








 

 

Our Commitment to Our Members

The Holman Group is committed to providing high-quality behavioral health services. We value member feedback and encourage members to share concerns, complaints, grievances, or appeals regarding services, providers, access to care, coverage determinations, or quality of care. Our grievance process is designed to ensure concerns are reviewed fairly, thoroughly, and in a timely manner.

 

What Is a Grievance?

A grievance is an oral or written expression of dissatisfaction regarding The Holman Group, a contracted provider, covered services, access to care, quality of care, administrative processes, or a benefit determination. Members may submit a grievance directly or authorize another individual to act on their behalf.

 

How to File a Grievance

A grievance may be submitted at any time by any of the following methods:

Assistance and Accessibility

The Holman Group is committed to ensuring that all members have access to and can fully participate in the grievance and appeal process. Assistance is available at no cost to members who have limited English proficiency, hearing or speech impairments, visual impairments, or other communication needs. Available services include interpreter services, language translation assistance, TTY/TDD services, and other auxiliary aids and services as appropriate. These accommodations are provided to help ensure meaningful access to grievance procedures, forms, communications, and support throughout the review process.

 

Standard Grievance Review Process

Step 1 – Submit Your Grievance Members may submit a grievance verbally or in writing through any of the methods listed above.
Step 2 – Acknowledgment The Holman Group will acknowledge receipt of the grievance within five (5) calendar days, unless the grievance is resolved immediately during the initial contact.
Step 3 – Investigation and Review

The Holman Group will conduct a thorough review of the grievance, including obtaining and reviewing relevant records, documentation, and information necessary to evaluate the concern.

Clinical grievances are reviewed by qualified clinical personnel, including licensed behavioral health professionals when appropriate.

Administrative grievances are reviewed by qualified grievance specialists and operational staff.
Step 4 – Written Resolution The Holman Group will provide a written resolution within thirty (30) calendar days of receiving the grievance unless a shorter timeframe is required by law.

 

Expedited (Urgent) Grievances and Appeals

An expedited review may be requested when applying the standard grievance timeframe could seriously jeopardize the member's life, health, mental health condition, safety, ability to attain, maintain, or regain maximum function, or subject the member to severe pain. Members or their authorized representatives may request an expedited review by calling The Holman Group at 800-321-2843.

 

Expedited Review Timeframe

The Holman Group will review and resolve expedited grievances and appeals as quickly as the member's condition requires and no later than seventy-two (72) hours after receipt of the request, unless a shorter timeframe is required by applicable law. If the request does not qualify for expedited review, the matter will be processed through the standard grievance process and the member will be notified.

 

Appeals of Adverse Benefit Determinations

If a member disagrees with a coverage, authorization, or medical necessity determination, the member may request an appeal. The member may submit additional information, records, or supporting documentation for consideration during the appeal review process.

 

Independent Medical Review (IMR)

Members enrolled in plans regulated by the California Department of Managed Health Care (DMHC) may have the right to request an Independent Medical Review (IMR) for certain medical necessity, experimental, investigational, or coverage disputes. Information regarding IMR eligibility and instructions will be included in applicable determination and appeal letters.

 

California Department of Managed Health Care (DMHC)

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have filed a grievance with The Holman Group and are dissatisfied with the outcome, or if your grievance has not been resolved within 30 days, you may contact the Department for assistance. You may also contact the Department immediately if your concern involves an urgent matter. The DMHC Help Center can assist members with grievances, appeals, and Independent Medical Review requests.

Website: www.dmhc.ca.gov

 

Non-Retaliation Statement

Members will not be discriminated against, penalized, or otherwise treated differently for filing a grievance, appeal, complaint, or requesting an Independent Medical Review.

 

Questions?

If you need assistance with a grievance, appeal, authorization, coverage determination, or access to care concern, please contact The Holman Group’s Grievance and Appeal Department at: