Department of Managed Health Care. The California Department of Managed Health Care is responsible for regulating health care service plans. (Health Net is a health care service plan.) If you have a grievance against Health Net, you should first telephone Health Net at 0-000-000-0000 and use our grievance process before contacting the Department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an Emergency, a grievance that has not been satisfactorily resolved by Health Net, or a grievance that has remained unresolved for more than 30 days, then you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the Medical Necessity of a proposed service or treatment, coverage decisions for treatments that are Experimental or Investigational in nature and payment disputes for emergency or urgent medical services. The Department also has a toll-free telephone number (0-000-XXX-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Department' s Internet Web site xxxx://xxx.xxxxxxx.xx.xxx has complaint forms, IMR application forms and instructions online. Binding Arbitration Sometimes disputes or disagreements may arise between you (including your enrolled Family Members, heirs or personal representatives) and Health Net regarding the construction, interpretation, performance or breach of this Evidence of Coverage or regarding other matters relating to or arising out of your Health Net membership. Typically such disputes are handled and resolved through the Health Net Grievance, Appeal and Independent Medical Review process described above. However, in the event that a dispute is not resolved in that process, Health Net uses binding arbitration as the final method for resolving all such disputes, whether stated in tort, contract or otherwise, and whether or not other parties such as employer groups, health care providers, or their agents or employees, are also involved. In addition, disputes with Health Net involving alleged professional liability or medical malpractice (that is, whether any medical services rendered were unnecessary or unauthorized or were improperly, negligently or incompetently rendered) also must be submitted to binding arbitration. As a condition to becoming...
Department of Managed Health Care. Without limiting the Parties' obligations under this Section 3, the Parties agree to cooperate with each other to address any issues, concerns or requests regarding the provisions of this Agreement or the provision or receipt of the Services with respect to PacifiCare of California (DMHC File No. 933-0126), PacifiCare Behavioral Health of California, Inc. (DMHC File No. 933-0301) and/or PacifiCare Dental (DMHC File No. 933-0100), expressed by the California Department of Managed Health Care ("DMHC") arising from or related to DMHC File 933-0100, "Amendment to Administrative and Solicitor Firm Services Agreement with Affiliate," which PacifiCare submitted to the DMHC on December 17, 2001 (the "DMHC FILING"). To the extent in responding to the DMHC Filing, the DMHC expresses requirements that necessitate changes to the Agreement or to the Services, which changes apply only because of the consummation of the transactions specified in this Agreement ("DMHC REQUIREMENTS"), the Parties agree to negotiate in good faith and to make equitable adjustments to this Agreement as may be necessary to accommodate the DMHC Requirements. If any DMHC Requirements require a material alteration to the Services, the Parties shall [...***...].
