Contact Us Grievances

LIBERTY Dental Plan

3200 El Camino Real, Suite 290
Irvine, CA 92602
(888) 703-6999
(949) 223-0007
Fax (949) 223-0011

Submit a Grievance
Member Name (required)	Plan Name
Member Home Address (required)	Group Name
City(required)	State(required)
Zip Code(required)
Home Phone Number (required)
Work Phone Number
Member E-mail Address(required)
Dentist/Facility Name (required)	Dental Office ID Number
Complaint (Please document as much as possible)
Recommendation (Action requested by user)
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 1-888-703-6999 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 remained unresolved for more than 30 days, you may call the Department for assistance. You may also be eligible for 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.
Download PDF Grievance Form