Appeals and Grievances

A grievance is an expression of dissatisfaction (other than an organization determination) with any aspect of the operations, activities, or behavior of a health plan, or its providers, regardless of whether remedial action is requested. Examples of grievances include:

  • Problems getting an appointment, or having to wait a long time for an appointment
  • Disrespectful or rude behavior by doctors, nurses or other plan clinic or hospital

Members can file a complaint with their respective health plan by phone, mail, or through the health plan's website. Health plans are required by law to have a grievance process in place to resolve enrollee complaints within 30 days. Search for Brown & Toland Physicians' contracted health plans below to locate the appropriate health plan form to complete.

If the health plan denies the request for medical services or treatment, a complaint (grievance/appeal) may be filed with the respective health plan. You can request an Independent Medical Review (IMR) with the California Department of Managed Health Care (DMHC) if there is a disagreement the health plan's decision, or it has been at least 30 days since the complaint has been filed with the health plan. The DMHC staff will determine whether the issue qualifies for an IMR.

Physician Dispute Resolution

If a physician wants to challenge, appeal, or request reconsideration of a claim or reimbursement, please see the bottom of webpage for Physician Disputes Resolution information within the provider portal.

Health Plan forms for Members to Begin the Appeal or Grievance

Aetna

Anthem Blue Cross Blue Shield

Blue Shield

Cigna

Health Net

Scan

San Francisco Health Plan

Sutter Health

United Health

Contact Information for Brown and Toland Physicians' Appeals and Grievances Department:

Email: Appeals@btmg.com
Telephone: (415) 972-4586
Fax: (415) 972-4149

Mail: Brown & Toland Physicians

Attn: Appeals & Grievance Department
PO Box 72710
Oakland CA 94612

Resources: