Here’s the official forms to request review of your cancellation for non-payment of premiums.

The one below we found on Sutter’s website and this one, one of our clients just got from Kaiser.

We checked with the Department of Health Care plans and they also gave us the IMR Independent Medical Review form  –  Which can also be completed ONLINE ==> Online Independent Medical Review/Complaint Form  The IMR is the preferred form, but they will accept the Review of Cancellation form.  I suggest – and I’m not an attorney, that you use the Review of Cancellation form as it asks better questions so that you can prove your point.  See also our appeals pages.

Department of Managed Health Care - Request Review of cancellation or recesions
Department of Managed Health Care – Request Review of cancellation or recesions

 

Related Pages in  Grace Periods? NEVER get cancelled Non-Pay!!! » Was the cancellation legal? Section

Other Pages in Appeals & Grievances Section

Medicare Appeals & Grievances

Insure Me Kevin.com

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