Employee Assistance Plan Grievance Form

Please complete this form to file a grievance.

Spring Health is committed to ensuring our subscribers and our members have a great experience with our service. As such, we recognize there are times when an employee and/or family member (“member”) may have a less than satisfactory experience with our services. In these situations, the Grievance Team will assist and strive to resolve any grievance within 30 days.

Applicable Timelines

Grievances must be submitted within 180 calendar days following the incident or action that is the subject of the member's dissatisfaction. We will acknowledge receipt of your Grievance within 5 calendar days from receipt unless the Grievance meets the definition of being urgent, in which case, we will acknowledge receipt within 72 hours. For non-urgent Grievances, we will respond with your Grievance resolution within 30 calendar days of receipt.

Available Assistance

If you need assistance to complete this form or have any questions about the grievance process, please call us at +1(855) 629 0554.

Spring Health makes interpreter services available to you at no cost. You may also request that documents be read to you and/or sent in your preferred language. For assistance, please call us at +1(855) 629 0554.

If you have any questions regarding the Grievance process, please contact grievances@springhealth.com.

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Attention California Members

Please review the following information.

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 1-855-629-0554 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 might 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 an 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 or 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 1-888-466-2219 and a TDD line 1-877-688-9891 for the hearing and speech impaired. The department's Internet Web site www.dmhc.ca.gov has complaint forms, IMR application forms and instructions online.

Mailing Instructions

IF YOU WOULD PREFER TO MAIL YOUR GRIEVANCE, PLEASE DOWNLOAD THE PDF ATTACHMENT BELOW. YOU CAN MAIL A COMPLETED FORM TO THIS ADDRESS: