GRIEVANCE FORM

If you have a complaint about any aspect of Modern Life, CA, Inc.’s services, you, your provider, or an attorney or representative on your behalf may file a grievance by 1) calling Member Services at 1-866-535-6463, 2) writing to the Member Services Department at the address below, or 3) by completing and submitting this Grievance Form.

The completed Grievance Form should be submitted either online or to the address below. Modern Life will resolve all standard, non-expedited grievances within thirty (30) days of receipt of a completed Grievance Form. The grievance system allows you to file standard or expedited grievances within 180 days of an incident or action with which you are dissatisfied. Please include any documents or information that you believe may be relevant to the review of your grievance.

Call: 1-866-535-6463 (TTY) for the hearing and speech impaired
Online: modernhealth.com
Write:
   Modern Life CA, Inc.
   Member Services Grievances
   650 California Street
   Floor 7, Office 07-128
   San Francisco, CA 94108

Expedited Decisions
You have the right to an expedited decision when the routine decision-making process might pose an imminent or serious threat to your health, including, but not limited to severe pain or potential loss of life or major bodily function. Expedited review also applies to grievances regarding cancellations, rescissions, and nonrenewals. Modern Life will evaluate your request and medical condition, if applicable, to determine if it qualifies for an expedited decision, which will be processed as soon as possible to accommodate the patient's condition, not to exceed 72 hours. To request an expedited decision, you or your provider on your behalf can call or write to Member Services, as described above. Specifically state that you want an expedited decision, and that waiting for the standard process might seriously jeopardize your health.

Department of Managed Health Care / Voluntary Independent Medical Review
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 1-866-535-6463 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 thirty (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 an 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.