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Grievances and Appeals

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Champion Health Plan is interested in hearing from you about what is working, as well as how you would like it to work.

We are interested in complaints you may have about services you received, the way you were treated, the care you received (or didn’t receive in a timely manner), if you were charged incorrectly, or any other complaint you may have. We want to correct any inappropriate behavior, processes, or payments. You will not be “in trouble” or mistreated by us or your doctors if you complain. We’ll make sure of it. Your calls help us improve.

Filing a Grievance or Complaint

The first step is to call and tell us your complaint. The representative who answers your call will write it down for you and will send it immediately to the Grievance Department.

If you do not wish to call, you can put your complaint in writing and send it to us by fax or letter. Write a description regarding what caused you to be unhappy or mad. In your description include dates, names, and tell us all about the problem. If you put your complaint in writing, we will respond to your complaint in writing. We will research the matter and respond to you within 30 calendar days of the receipt of your complaint.

Appeals and Grievance Department

Phone 1-800-885-8000 | TTY: 711
Fax (949) 227-3791

Contact Hours of Operation
April 1 – September 30
Monday – Friday, 8 a.m. – 8 p.m.

October 1 – March 31
7 days a week, 8 a.m. – 8 p.m.

Email
Grievance.Appeals@championpayer.com

Mail Address
Attn: Appeals and Grievance Department

P.O. Box 15337
Long Beach, CA 90815-9995

Whether you call or write, you should contact us as soon as possible after the incident. Complaints should be made within 60 calendar days of the day you had the problem.

We will look into your complaint and give you an answer. We must respond whether we agree with the complaint or not.

  • If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer at the time you call.
  • Most complaints are answered in 30 calendar days. If your health condition requires us to answer more quickly, we will do that. If we need more information and the delay is in (44 calendar days total) to answer your complaint.
  • If you are making a complaint because we denied your request for a “fast coverage decision” or a “fast appeal,” we will automatically give you a “fast” complaint. If you have a “fast” complaint, it means we will give you an answer within 24 hours.

You also have the right to request information on the aggregate number of grievances, appeals and exceptions that Champion Health Plan has received. Please contact us via phone, mail or email using the Appeals & Grievances Department information provided above.

If we are not helping with your complaint, you can submit a complaint about Champion Health Plan directly to Medicare. Medicare takes your complaints seriously and will use the information to help improve the quality of the Medicare program.

If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call1-800-MEDICARE (1-800-633-4227), available 24 hours, 7 days a week including some federal holidays. TTY/TDD users can call 1-877-486-2048.

To submit a complaint to Medicare, go to:
https://www.medicare.gov/MedicareComplaintForm/home.aspx