Appeals and Grievances
Appeals and Grievances
There may be times when members have a complaint or disagree with a decision that was made by Jade Health Care Medical Group or by a contracted provider about benefit coverage, services or non-payment of care/service. Members may also express concerns about an experience they had with some aspect of their care/service. In these instances, members, or their designated representative (who may be their physician acting on their behalf) have the right to file an appeal and/or a grievance.
An appeal is a complaint about a coverage decision, including a denial of payment for a service received, or a denial in providing a service a member feels they are entitled to as a Jade Health Care Medical Group member. Coverage decisions that may be appealed include a denial of payment for any health care services they received, or a denial of a service that they believe should have been arranged for, furnished, or paid for by Jade Health Care Medical Group.
A grievance is a complaint about a problem a member observes or experiences, including complaints about the quality of services that they receive, complaints regarding such issues as office waiting times, physician behavior, adequacy of facilities, or other similar concerns.
How to File a Complaint – Appeal or Grievance
You may use the following ways to file a Member Grievance:
San Francisco Health Plan (SFHP) Members:
By Phone: You may call SFHP's Customer Service hotline at 1-415-547-7800 (local) or 1-800-288-5555 (Toll Free), Monday to Friday, between 8:30 am to 5:30 pm.
In Person: You can visit SFHP's Service Center located at:
7 Spring Street. San Francisco, CA 94108
or you can also visit the Jade/CCHP Member Services Office located at:
445 Grant Ave, Ground Floor, San Francisco, CA 94108
from Monday to Friday, between 8:30 am to 5:00 pm.
Electronically: You can visit SFHP's website at: https://www.sfhp.org/about-us/grievance-info
Chinese Community Health Plan (CCHP) Members:
By Phone: You can call Jade/CCHP Member Services at 1-415-834-2118, Monday to Sunday, from 8:00 am - 8:00 pm.
In Person: You may visit the Jade/CCHP Member Services Office located at 445 Grant Ave, Ground Floor, San Francisco, CA 94108 from Monday to Saturday, 8:30 am - 5:00 pm.
Electronically: You can visit CCHP's website at: https://cchphealthplan.com/file-appeal-grievance