WDS strives to provide excellent service to our members and patients. If you have a concern, you are encouraged to call the WDS Member Service Department at 1-800-992-3366 to obtain assistance. Grievance forms and initiating a grievance are available in person, online, by telephone or in writing. Upon your request, a WDS representative may fill out the form and initiate the grievance over the telephone. Grievance forms are also available at your dental provider’s office.
Grievance forms and assistance with the grievance process are available in other languages by calling the WDS Member Service Department at (1-800-992-3366). WDS will allow a grievance to be filed for at least 180 calendar days following any incident or action that is the subject of dissatisfaction. WDS will acknowledge receipt of your grievance in writing within five days of WDS’ receipt of the grievance (or orally if your telephonic grievance is not a coverage dispute, disputed health care service involving medical necessity or experimental or investigational treatment, and is resolved by the close of the next business day), which will include the name, title and contact information of the staff member who may be contacted to discuss the case, if applicable. You will receive a response within 30 days (or within 3 days from receipt of a grievance that indicates there is an immediate and serious threat to your health).
The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your Health Plan, you should first telephone your Health Plan at 1-800-992-3366 and use your Health Plan's 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 your Health Plan, or a grievance that has remained unresolved for more than 30 days, you may call the Department 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 (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department's Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online."