Online Grievance Form

ONLINE GRIEVANCE FORM

The health and satisfaction of our members is SIMNSA’s foremost priority. SIMNSA staff are available from 8am to 5pm to address any questions or concerns you may have. If for any reason you are dissatisfied with the care you have received or with a determination made by SIMNSA, you have the right to file a grievance with SIMNSA. You can submit your grievance verbally or in writing within 180 days of the date of the incident that caused your dissatisfaction. You or your representative may submit your grievance in one of the following manners:

• In person to a SIMNSA representative at your local SIMNSA office
• In writing by submitting a written grievance to 2088 Otay Lakes Rd #102, Chula Vista, CA 91913
• By telephone to (800) 424-4652 (English and Spanish); TTY: 1-888-889-4500
• Through our website at https://simnsa.com/online-grievance-form/

After receiving your grievance, SIMNSA will provide a response within 30 days. If your matter is urgent such that there is an imminent and serious threat to your health, SIMNSA will provide a response within three (3) calendar days from the receipt of your grievance.

TTY/TDD users can dial 711 or use the California Relay Service’s toll-free phone numbers.

Voice to TTY
1-800-735-2922

Voz y TTY (teléfono de texto)
1-800-855-3000

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 800-424-4652 and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.