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Appeals and Grievances
Employer Group Medicare Members

Many issues or concerns can be promptly resolved by our Member Services Department. If you have not already done so, you may want to first contact Member Services before submitting one of the forms below.

Health Net encourages you to provide a detailed account of your experience. Your feedback is important to us and we appreciate the time you have taken to share this information. We hope that you will allow us to continue to serve you and provide the excellent service that you deserve.

If you believe a delay in the decision making may impose an imminent and serious threat to your health, please contact customer service using the toll-free telephone number on your ID card to request an expedited review.

File Appeals and Grievances

You may file an appeal or grievance using these methods:

  • Online: Employer Group Medicare Online Grievance Form

  • Call our Customer Service Department

    • April 1 – September 30 *
      Monday through Friday, 8:00 a.m. to 8:00 p.m.
    • October 1 – March 31 *
      7 days a week, 8:00 a.m. to 8:00 p.m.

      *A messaging system is used after hours, weekends, and on federal holidays.
Health Plan Type
Health Plan Type Phone Number
All Health Net Amber (HMO SNP) plans 1-800-431-9007
All Health Net Healthy Heart (HMO) plans 1-800-275-4737
All Health Net Green (HMO) plans 1-800-275-4737
Health Net Jade (HMO SNP) 1-800-431-9007
All Health Net Ruby (HMO) plans 1-800-275-4737
Health Net Gold Select (HMO) 1-800-275-4737
Health Net Violet (PPO) 1-888-445-8913
Health Net Seniority Plus Sapphire and Sapphire Premier (HMO) plans 1-800-275-4737
TTY 711

For Quality Improvement Organization (QIO) Complaints, please contact:

Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701

Type of Call
Type of Call Phone Number
Toll-free Number: 1-877-588-1123
TTY: 1-855-887-6668
Fax: 1-844-273-2671
  • By Mail or Fax

    You may mail or Fax your appeal or grievance via a written letter or by using one of our forms provided below.

    • Medical Services:
      Health Net Appeals & Grievances Medicare Operations
      PO Box 10450
      Van Nuys, CA 91410-0450
    • Prescription Drug Services:
      Health Net; Appeals & Grievances Medicare Operations
      P.O. Box 10450
      Van Nuys, CA 91410-0450
    • Fax: 1-844-273-2671

Select the appropriate Appeals or Grievance Form below

Use this form when appealing the denial of a medical or prescription drug service, claim, or copay/benefit:

Drug Coverage Redetermination Forms

Use this form to express your dissatisfaction with the care or service(s) you have received:

Appeals Procedures for your Employer-Sponsored Benefits

There is a special type of Appeal that applies only to Employer-Sponsored Benefits. Employer-Sponsored Benefits are covered benefits that are beyond the basic Medicare-covered benefits or Part D Drug benefits.

This section explains what you can do if you have problems getting Employer-Sponsored Benefits you believe we should provide.

If you disagree with our initial decision about your care or paying for your care, you may ask us to reconsider our decision. This is called an "Appeal." You can file the Appeal by calling Health Net Member Services Department at 1-800-275-4737 (TTY: 711) 8:00 a.m. to 8:00 p.m., Monday-Friday or by sending information to:

Health Net Appeals & Grievances Medicare Operations
PO Box 10450
Van Nuys, CA 91410-0450

We will:

  • Review your complaint and inform you of our decision in writing within 30 days from the receipt of the Appeal. For conditions where there is an immediate and serious threat to your health, including severe Pain, or the potential for loss of life, limb or major bodily function exists, we must notify you of the status of your grievance no later than three days from receipt of the grievance.
  • Inform you if additional time is necessary to complete our investigation.

You must file your Appeal with Health Net within 365 calendar days after we notify you of the Initial Decision. Please include all information from your Health Net Identification Card and the details of the concern or problem. After reviewing your Appeal, we will decide whether to stay with our original decision, or change this decision and give you some or all of the care or payment you want.

Review of your request by an Independent Review Organization

If you are not satisfied with the outcome of your above Appeal, you can request for an independent review organization to review your case. This organization will review your request and make a decision about whether we must give you the care or payment you want. You may call Health Net Member Services Department at 1-800-275-4737 (TTY: 711) 8:00 a.m. to 8:00 p.m., Monday - Friday to request the independent review or by sending the request to:

Health Net Attn: Medicare Appeals & Grievances Department
PO Box 10450
Van Nuys, CA 91410-0450

The review is conducted by an independent Physician reviewer with appropriate expertise in the area of medicine in question who has no connection to us. The independent review organization will provide its decision within 30 days after receiving the request for review and the supporting documents. If there is an immediate and serious threat to your health, an expedited review will be completed within 72 hours, or sooner if medically indicated.

Binding Arbitration

If you continue to be dissatisfied after the independent review process listed above has been completed, you may then initiate binding arbitration as described in the "Legal Notices" section of the Evidence of Coverage. Binding arbitration is generally the final process to resolve disputes concerning Employer-Sponsored Benefits.

Last Updated: 09/23/2022