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Grievance Form: Member Grievance Procedure

EYEXAM of California has established a system to ensure that member complaints are given prompt attention. You can submit a complaint to EYEXAM of California through this website by clicking below.

You can also file a complaint by contacting EYEXAM of California at: 1-888-439-3392, by TDD 1-949-364-1289 for the hearing impaired, by submitting an electronic mail to: grievancecoordinator@luxotticaretail.com , or by filling out a suggestion/complaint form available at any EYEXAM of California optometric office and mailing the completed form to EYEXAM of California at the following address:

EYEXAM of California, Inc.
P.O. Box 2756
Mission Viejo, CA 92690

If you need assistance or have questions regarding the grievance process, please call EYEXAM at 1-888-439-3392. The Plan also has a TDD line 1-949-364-1289 for the hearing impaired.

If necessary, assistance for those with limited English proficiency or with visual or other communicative impairment is available without charge to assist in the submission and resolution of grievances. EYEXAM of California will ensure that there is no discrimination against any member on the grounds that the member filed a complaint. EYEXAM of California will acknowledge receipt of your complaint in writing within 5 days of receipt and advise you in writing of the disposition of the matter within 30 days of receipt. EYEXAM of California allows for an expedited response to grievances involving an imminent and serious threat to the health of the patient, including but not limited to, severe pain, potential loss of life, limb, or major bodily function. Upon notice of a grievance involving imminent and serious threat to your health, EYEXAM of California will inform you of your right to notify the California Department of Managed Health Care and provide you and the department with a written statement of the disposition or pending status of such grievance no later than 3 days of receipt of the grievance.