![]() Your health plan requests that you submit your appeal within 60 days of your medical group's/IPA's final determination. If you believe that the resulting determination is not correct, you, or a representative appointed by you to act on your behalf, has the right to appeal through your health plan. Member's Rights to Appeal a Denied Service & Appeal Process The Peer Review Organization review process is designed to help stop any improper practices. ![]() Peer Review Organizations are groups of doctors and health professionals that monitor the quality of care provided. If you are concerned about the quality of care you have received, you, or a representative appointed by you to act on your behalf, may also file a complaint with the local Peer Review Organization, California Medical Review, Inc. Peer Review Organization Complaint Process Please refer to your health plan member materials for more detailed instructions on how to file a complaint/grievance. This process is separate from the appeal process described in the "Member's Rights to Appeal a Denied Service & Appeal Process" section below. The grievance process allows the member to file a complaint with the health plan about issues other than a denied service. The health plan refers to this process as a "grievance". You, or a representative appointed by you on your behalf, may file a written quality complaint with your health plan. Health Plan Quality Complaint "Grievance"
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