Member Grievance Forms and Links

Physicians Medical Group of San Jose in partnership with Regional Medical Center, and O'Connor Hospital work together... more>>

At Physicians Medical Group, we believe in the philosophy of preventive medicine. Our goal is to keep the people in our community healthy...more>>

Grievance Forms and Links

Aetna Grievance Form English
Aetna Grievance Form Spanish

Blue Cross Grievance Form English
Blue Cross Grievance Form Chinese
Blue Cross Grievance Form Korean
Blue Cross Grievance Form Spanish
Blue Cross Grievance Form Tagalog
Blue Cross Grievance Form Vietnamese

Blue Shield Grievance Form English

Cigna Grievance Form English
Cigna Grievance Form Spanish

Health Net Grievance Form English
Health Net Grievance Form Spanish

PacifiCare Member Grievance Forms can be obtained in the following ways:

•	Log onto the PacifiCare Member Portal at: www.pacificare.com
•	Log onto the PacifiCare Provider Portal at: www.pacificare.com
•	Call PacifiCare Customer Care at 1-800--624-8822
•	Call your UnitedHealthCare Provider Advocate

Pacificare Grievance Form English
Pacificare Grievance Form Spanish
Pacificare Grievance Form Chinese

The ways you may report a problem (or grievance) to us are:

• Call our toll-free number 1 (800) 260-2055 or TDD 1-800-735-2929,
or come into our offices at either

210 East Hacienda Avenue,
Campbell, CA 95008

or our Family Resource Center at

1775 Story Road, Suite 130
San Jose, 95122
Monday - Friday, between 8:30 am and 6:00 pm.

• Write our Grievance Manager at Santa Clara Family Health Plan, 210 East Hacienda Avenue, Campbell, CA 95008.
• Fill out our Member Grievance Form by clicking here.

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