You Have a Grievance
A grievance is a written complaint or concern about a medical provider, TAMS or the ONA Healthcare program in general. Authorization appeals, UNDER CONSTRUCTION”> claims appeals and claim review issues are separate from grievances. The following are examples of grievances:
Note: Disputing
Who can file a grievance?
Anyone can file a grievance; however, if the grievance is about someone other than the person who filed the grievance, ONA Healthcare may not be able to give a full response without an Authorization for Disclosure of Medical or Dental Information form on file. This generally applies to spouses and parents of adult children submitting grievances about their spouse or adult child.
What is the grievance process?
ONA Healthcare takes complaints seriously and conducts a thorough investigation of the concerns and takes actions as necessary to improve services. If necessary, we will contact the involved provider(s) and various ONA Healthcare departments to gather additional information. Generally, we do not contact the member unless information in the grievance is unclear. The person who submitted the grievance will receive a written response, usually within 60 days.
How is a grievance submitted?
Print an OHC Grievance Form or
send a letter with the following:
Fax to: 1-805-375-6090
Mail to: NOVA Pathfinder Limited
ONA Healthcare Grievances
5739 Kanan Road, Suite 335
Agoura, CA 91301