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, from 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.
- How to properly terminate coverage
- Never got bill?
- Request Review of alleged wrongful cancellation
Other Pages in Appeals & Grievances Section
- Covered CA Appeals
- How Steve Shorr Insurance can help you
- Technical Links – Appeals & Grievances