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 appealsUNDER CONSTRUCTION”> claims appeals and claim review issues are separate from grievances. The following are examples of grievances:

  • The quality of
    care given by a provider (inappropriate care, not enough care, poor
    results)
  • The attitude or behavior of providers and their staff
  • Incorrect information
  • Delays or errors in processing authorizations
  • Patient safety issues at a facility or doctor’s office
  • Privacy concerns

Note: Disputing charges for services should not be submitted as a grievance. Please visit our Disputing Provider Point of Service Charges page to learn more.

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:

  • name, address and telephone number of the person submitting the grievance
  • the member’s name, address and telephone number if different from the submitter
  • the member’s Social Security number or the beneficiary’s Social Security number
  • a description of the issue(s), including the day, time and details
  • the name of the involved provider(s) or OHC associates
  • the provider’s address if the complaint is about a provider
  • any appropriate supporting documents
  • if necessary, an Authorization for Disclosure of Medical or Dental Information form

Fax to: 1-805-375-6090

Mail to: NOVA Pathfinder Limited
ONA Healthcare Grievances
5739 Kanan Road, Suite 335
Agoura, CA 91301