Appeals & Grievances

Have a concern? We're here to help.

If you have a concern about your care, coverage, or experience, please contact Member Services. We can help answer your questions, address your concerns, and explain your options for filing a grievance or appeal.

Call Member Services

1-833-627-8252 (TTY 711)

April 1st through September 30th, 8am-8pm PST, Monday – Friday. Closed all Federal Holidays. October 1st through March 31st, 8am – 8 pm PST, 7 days a week. Closed Thanksgiving and Christmas Day.

What Is a Grievance?

A grievance is a formal complaint about your care, service or experience with your health plan or a provider. This may include concerns about the quality of care or service you received, customer service, or other aspects of your experience.

A grievance does not include a complain about a coverage or payment decision. If you disagree with one of these decisions, you may have the right to file an appeal.

Decisions made under the grievance process cannot be appealed.

Learn more about grievances: https://cms.gov/medicare/appeals-grievances/managed-care/grievances

What Is an Organization Determination (Initial Determination)?

An organization determination is a decision about your Medicare Advantage coverage. This may include a decision about:

Whether a health care item or service is covered or will be paid for;
How much you are required to pay for an item or service; or
How many items or services you can receive.

If you are unsure whether an item or service will be covered, you, your representative or your provider can request an organization determination before you receive the service.

Important to know: A provider's decision not to provide an item or service based on medical judgement or willingness to provide the service is a treatment decision and is not an organization determination.

Learn more about organization determinations: https://cms.gov/medicare/appeals-grievances/managedcare/organization-determinations

What Is an Appeal (Reconsideration)?

If you disagree with an organization determination about your coverage or payment, you have the right to ask for the decision to be reviewed. This is called an appeal, or reconsideration.

As part of the appeal process, the original decision will be reviewed along with any additional information or supporting documentation your provide.

You can file an appeal or grievance here. Have questions? Contact Member Services at 833-627-8252 (TTY 711). We can help explain the appeal process and help you understand your next steps.

Learn more about appeals (reconsideration): https://cms.gov/medicare/appeals-grievances/managedcare/reconsideration-advantage-health-plan-part-c

Filing a complaint with Medicare

You also have the option to file a complaint about your Medicare health plan directly with Medicare.

To file a complaint online, visit Medicare's complaint form below. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048

File a complaint with Medicare: Medicare Complaint Form - Start

For accommodations of persons with special needs at meetings, call 844-590-1757 (TTY 711).

UCLA Health Medicare Advantage Plan (HMO) has a contract with Medicare and enrollment in the plan depends on contract renewal. UCLA Health Medicare Advantage Plan includes Part D drug coverage. To enroll in UCLA Health Medicare Advantage Plan, you must have both Medicare Parts A and B and reside in the plan service area, Los Angeles County. In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium.

Please contact Member Services at 1-833-627-8252 (833-MAP-UCLA) (TTY 711) for additional information. Hours are 8am - 8pm PT, Monday - Friday, April 1 through September 30, except on all federal holidays. Hours are 8am - 8pm PT, 7 days a week, October 1 through March 31, except Thanksgiving Day and Christmas Day.

Members enrolled in UCLA Health Medicare Advantage Plan (HMO) must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from UCLA Health Medicare Advantage Plan, neither Medicare nor UCLA Health Medicare Advantage Plan will be responsible for the costs. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Every year, Medicare evaluates plans based on a 5-star rating system.

Access to specialty healthcare services is provided by American Specialty Health Group, Inc., a subsidiary of American Specialty Health Incorporated.

&more Benefits Prepaid Mastercard® is issued by Avidia Bank, pursuant to a license from Mastercard Incorporated. Use of this card is subject to the terms and conditions of the Cardholder Agreement. You will receive a PIN upon activation.

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Last Updated on 09/29/2026