For Eyes Vision Plan is providing this Online Grievance Form to you to ensure member complaints are heard and responded to in a timely manner. For Eyes Vision Plan has established a system to give your concerns prompt attention. Alternatively, you may submit an online Grievance in Chinese and Spanish.

You may also file your grievance over the telephone by calling For Eyes Vision plan at:

800-454-3937

You can also submit your complaint by e-mail to grievance coordinator@foreyes.com or mail your completed form to:

For Eyes Vision Plan, Inc. 2112 Shattuck Avenue Berkeley, CA 94704

You can access the online form with the link above or click on the link for the form in the appropriate language:

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 800.454.4647 and use your health plan's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for ail Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1·888·HMO·2219) and a TDD line (1 877 688 9891) for the hearing and speech impaired, The department's internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.