Do you have a complaint?
If you are dissatisfied with California Kids Care or a California Kids Care provider, contact CKC Member Services and let us help you resolve the problem. You may also file a formal grievance (complaint).
To request grievance forms, file a verbal grievance and/or request information regarding the grievance process, Members may call CKC Member Services, toll-free at 1-844-225-5430 (TTY 711) during normal business hours. California Kids Care will provide a grievance form upon request, either directly or by mail, if mailing is requested, to any family requesting the form. California Kids Care will provide reasonable assistance to any Member or family requesting assistance with completing the grievance form.
To file a grievance
- Fill out and return the grievance form. Please describe the problem in detail, including information such as where and when it happened, who was involved, and what you believe California Kids Care can do to resolve the problem.
- California Kids Care will send you a written acknowledgement of your grievance within five days, and a decision letter within 30 days.
- If the grievance involves and imminent and serious threat to your health, including but not limited to , severe pain, potential loss of life, limb or major bodily function, we will provide you with a decision within 3 calendar days.
- For additional information about grievance, please consult the Member Handbook or the California Kids Care Grievance and Appeals policy.
Grievances can be submitted to:
California Kids Care
Rady Children’s Hospital – San Diego
Grievance and Appeals Resolution Services
3020 Children’s Way, MC 5149
San Diego, CA 92123-4282
Phone: 1-844-225-5430 (TTY 711)
or via email at CaliforniaKidsCare@rchsd.org
File a grievance with the Department of Managed Health Care
The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against California Kids Care, you should first telephone California Kids Care at 1-844-225-5430 (TTY 711) and use California Kids Care’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-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s Internet Web site https://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.