Grievances & Appeals

Standard Appeals

You can ask for a standard appeal. Your plan must give you a decision no later than 30 days after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if it needs additional information and the extension benefits you.)

Expedited (Fast) Appeals

You can ask for a fast appeal if you or your doctor believe that your health could be seriously harmed by waiting too long for a decision. Your plan must decide on a fast appeal no later than 72 hours after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if your plan needs additional information and the extension benefits you.)

  • If any doctor asks for a fast appeal for you, or supports you in asking for one, and the doctor indicates that waiting for 30 days could seriously harm your health, your plan will automatically give you a fast appeal.
  • If you ask for a fast appeal without support from a doctor, your plan will decide if your health requires a fast appeal. If your plan does not give you a fast appeal, your plan will decide your appeal within 30 days.

Please download this form to file a formal appeal regarding any aspect of the medical care or service provided to you.

The process for coverage decisions and appeals can be found in Chapter 9 of your evidence of coverage (EOC). This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Please refer to Chapter 9 of your EOC for a full description of the process.

Grievances

Please download this form to file a formal grievance regarding any aspect of the medical care or service provided to you.

Appointment of Representative

An appointed representative is a person who can act on your behalf to request an exception, appeals or grievance. This person can be a relative, friend, advocate, doctor, or anyone else whom you trust to act on your behalf. The Appointment of Representative form can be found here:

Astiva Health wants to hear from you.

You may request grievance data orally or in writing by contacting the Member Services Department.

For questions regarding the appeal or grievance process, please see the contact information below.

CALL US

1-866-688-9021, TTY:711
Monday – Friday
8:00 AM – 8:00 PM (PST)

WRITE TO US

Appeals and Grievances
PO Box 4405
Costa Mesa, CA 92628

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