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 MEMBER INFORMATION  
 California members may obtain and submit a Member Grievance Form by mail, fax, telephone, or online at www.familycarecard.com or www.servicemyplan.com. If a California member remains dissatisfied after going through Family Care's complaint resolution process, he or she may contact the Department of Managed Health Care by calling toll-free (1-888-466-2219 or TTD line 1-877-688-9891 for the hearing and speech impaired) or online at http://www.hmohelp.ca.gov. Please use this form to submit grievances to Family Care. We will address your concerns and provide you with a response in the shortest amount of time possible. Please note that we can obtain faster resolution to your concerns if you provide us with complete information. You may submit the completed form by mail, please print the completed form and send it to: Family Care, ATTN: Sam Hamadeh, Director of Quality Assurance, 11111 Richmond Ave., Suite 200, Houston, TX 77082, fax to 713-414-4953, or online by clicking "DONE" at the end of this form. Required fields are indicated with an asterisk (*)  

 
  The information you provide will only be used to attempt to obtain a resolution to your grievance. If you have any questions, you may call us at (800) 853-9594.
   
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