Anthem Blue Cross : Member Grievance Forms

Member Grievance Forms

PW_A114738

Medi-Cal, L.A. Care, Healthy Families, MRMIP, and AIM

Please print out and complete this form and attach any related documents. Mail the form and documents to:  

Attn: Grievance Coordinator

Anthem Blue Cross

P.O. Box 60007

Los Angeles, CA 90060-0007

 
You may also file a grievance by calling the Customer Care Center or Member Services number on your Anthem Blue Cross ID card. You will be sent a response within 30 calendar days of us receiving this form or your call. 
This 1-page brochure spells out the following phrase in 12 different languages: "If you need an interpreter, point to your language and we will call one for you. This service is free." 
Member Grievance Forms (PDF) 

Arabic

Armenian

Chinese

English

Farsi

Hmong

Khmer

Korean

Russian

Spanish

Tagalog

Vietnamese

 

® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2011 Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.