Federal law guarantees your right to make complaints if you have concerns or problems with any part of your medical care as a plan member.   Medicare has helped set the rules about what you need to do to make a complaint, and what we are required to do when we receive a complaint.   If you make a complaint, we must be fair in how we handle it.   You cannot be disenrolled from Brand New Day or penalized in any way if you make a complaint.

You have the right to make a complaint if you have concerns or problems related to your coverage or care. “Appeals” and “grievances” are the two different types of complaints you can make.

• An “appeal” is the type of complaint you make when you want us to reconsider and change a decision we have made about what services are covered for you or what we will pay for a service. For example, if we refuse to cover or pay for services you think we should cover, you can file an appeal. How to Appeal decisions about medical care or claims.
• A “grievance” is the type of complaint you make if you have any other type of problem with Brand New Day Brand New Day or one of our plan providers. For example, you would file a grievance if you have a problem with things such as the quality of your care, waiting times for appointments or in the waiting room, the way your doctors or others behave, being able to reach someone by phone or get the information you need, or the cleanliness or condition of the doctor’s office.

If you are concerned about the quality of care you received, including care during a hospital stay, you can also complain to an independent organization called Health Services Advisory Group (HSAG). Their address is 700 N. Brand Blvd, Suite 470, Glendale, CA 91203. Telephone number is 800-841-1602 and 800-881-5980 for TTY. Additional information regarding HSAG is available in your Evidence of Coverage.

Brand New Day Appeal & Grievance Form

You may use the following Appeal & Grievance form for your written complaint - Member Appeal & Grievance Form.

Write: Brand New Day
Attention: Grievance and Appeal Department
1680 E. Hill Street
Signal Hill, CA 90755

Call: (866) 255-4795 TDD/TTY (866) 321-5955
Fax: (562) 981-5818 Attention: Grievance and Appeal Department daily from 8 a.m. to 8 p.m.

How to get help when you are asking for an appeal or grievance. You can name someone to make a grievance or appeal for you. There may be someone who is already legally authorized to act as our representative under State law. Or you can appoint a friend, relative or other person by completing an "Appointment of Representative Form"

A complete description of the grievance and appeal processes can be found in your Brand New Day Evidence of Coverage. If you would like to obtain the aggregate number of grievances and appeals received by Brand New Day please call Customer Service.