Grievances & Appeals

How to Express a Concern or Dissatisfaction
with Care or Service

As a participant of the On Lok Lifeways PACE program, it is your right to voice your concerns and file a complaint at any time, without fear of reprisal from staff.

In order to better serve you, we have grouped concerns and dissatisfaction into two categories:

Grievances

The On Lok Lifeways PACE program considers a “grievance” as any complaint, either written or oral, that expresses dissatisfaction with how we deliver our services or the quality of care that we provide. For information about how to file a grievance, please read the On Lok Lifeways Information for Participants about the Grievance Process in your preferred language below.

English | Chinese | Spanish | Vietnamese | Hindi

Appeals

When the On Lok Lifeways PACE program decides not to cover or pay for a service you want, you may take action to change our decision. The action you take—whether verbally or in writing—is called an “appeal”. For information about how to file an appeal, please read the On Lok Lifeways Information for Participants about the Appeals Process in your preferred language below.

English | Chinese | Spanish | Vietnamese | Hindi

There are several ways to file a grievance or an appeal. You can complete one of the following options:

Submit a grievance or an appeal using our online form

Our Online Grievance and Appeals Form is available online. To access our online form, please click the button below.

Submit a grievance or an appeal in person or by mail

You can print and complete a grievance or appeals form and deliver it in person or by mail to the Health Plan Associate.

On Lok Lifeways
Health Plan Associate
1333 Bush Street
San Francisco, CA 94109

To access our grievance or appeals form, please select your preferred language below.

Grievances

English | Chinese | Spanish | Vietnamese | Hindi

Appeals

English | Chinese | Spanish | Vietnamese | Hindi

Submit a grievance or an appeal by telephone, fax or email

You can call, fax or e-mail the Health Plan Associate to submit a grievance or an appeal.

Telephone: 415-292-8895
Toll-Free: 1-888-996-6565
For the Hearing Impaired: TTY 711
Fax: 415-292-8745
Email: memberservices@onlok.org

After you submit a grievance or an appeal, our Health Plan Associate will contact you for further information. You can contact our Health Plan Associate at 415-292-8895 or 1-888-996-6565. For the hearing impaired, please call our TTY number, 711.

For more information about the Grievance and
Appeals process, you can also contact:

California Department of
Managed Health Care Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Telephone: 1-888-466-2219
TDD: 1-877-688-9891
Website: http://www.hmohelp.ca.gov

 

Appointment of Representative

You can appoint a representative to act on your behalf to file a grievance or an appeal for you. The individual may be a family member, caregiver, friend, or anyone else who you trust that can act on your behalf. To name an individual, complete the appropriate Appointment of Representative Form for Medicare or the Appointment of Representative Form for Medi-Cal.

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