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How to Complete a Grievance

Category: File a Grievance

When to Use the SCAN Grievance Report Form

You may use this form when you have a complaint such as: 

When Not to Use the SCAN Grievance Report Form

Do not use this form if your complaint is about a decision regarding the denial of services or payment. Instead, you will need to file an appeal. Please refer to your Evidence of Coverage (EOC) to find out how to file an appeal. Or call Member Services at 1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day.

Online Grievance Form

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