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Grievances, Appeals and State Fair Hearings

If you have a problem with your health plan, care, provider or services, you can file a complaint with the plan. This is called a Grievance. A Grievance is an expression of dissatisfaction about any matter other than an adverse determination such as: Wait time to see a doctor, being treated unfairly by office staff, and unclean facilities.  If you get a letter saying something was denied, stopped, or reduced you can ask for an appeal. You can file a grievance or appeal by phone, email, mail, fax, or in person. You can ask for the grievance or appeal yourself or you can ask someone such as your doctor or family to request it for you. If you need help please call our Member Services number they can help you. To request an appeal or grievance you can:

  • Call Member Services at 1-833-752-1665 (TTY: 711)
  • Mail your request to us at:

Oklahoma Complete Health
ATTN: Grievances and Appeals
PO Box 10353
Van Nuys, CA 91410-0353

If your appeal is related to behavioral health services, you may request an appeal by:

Oklahoma Complete Health
ATTN: Grievances and Appeals
PO Box 10378
Van Nuys, CA 91410-0353

We can provide translation or interpreter service if you need it.

State Fair Hearings

After you receive a notice of adverse resolution to your appeal and you still don’t agree with the decision that we made that reduced, stopped, or restricted your services, you can ask for a State Fair Hearing. A State Fair Hearing is your opportunity to give more information and ask questions about the decision in front of an administrative law judge. The judge in your State Fair Hearing is not a part of your health plan in any way.

If you want to continue benefits while you wait for the administrative law judge’s decision about your State Fair Hearing, you should say so at the time you request a State Fair Hearing.

  • If you need help with understanding the State Fair Hearing process, you can call Member Services at 1-833-752-1665 (TTY: 711). You don’t have to use any special legal or formal language to request a State Fair Hearing as long as you clearly state that you are dissatisfied with the decision we made.

Your Care While You Wait for a Decision on your State Fair Hearing

  • If you requested and received continued services during your appeal, we must continue providing those services until you do one of the following:
    • You withdraw your appeal or your request for State Fair Hearing, or
    • A State Fair Hearing officer issues a hearing decision that disagrees with you.
  • You can also ask a trusted representative to make that request for you.
  • If you ask your health plan to continue services you already receive during your State Fair Hearing case, the health plan will pay for those services if your case is decided in your favor. Your State Fair Hearing might not change the decision the health plan made about your services.

You can find detailed information about grievances, appeals and fair state hearing process in our Member Handbook (PDF).

Last Updated: 01/02/2024