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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.

Enrollee Rights to Submit an Urgent Grievance Letter

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 receiving notice of a grievance involving imminent and serious threat to your health, EYEXAM of California shall do the following:

  1. EYEXAM of California shall immediately inform you of your right to notify the Department of Managed Health Care of the existence of the urgent grievance.
  2. EYEXAM of California shall provide you and the Department with a written statement via resolution letter on the disposition or pending status of the urgent grievance within 3 days of receipt.
  3. Your medical condition shall be considered when determining the response time.
  4. If your complaint is outside the scope of services provided by EYEXAM of California, as described in the Evidence of Coverage, you shall be referred to your primary care physician or a hospital emergency room.
  5. All correspondence or other communication involving urgent grievances shall be documented and retained by the Grievance Coordinator.