
Member Services
Toll free: 1-800-750-4776
Local: 650-616-2133
TTY: 1-800-735-2929 or dial 7-1-1
Phone hours: Monday–Friday 8:00 a.m. to 6:00 p.m.
Office hours: Monday–Friday 8:00 a.m. to 4:00 p.m.
Email: CustomerSupport@hpsm.org
CareAdvantage Unit
Toll free: 1-866-880-0606
Local: 650-616-2174
TTY: 1-800-735-2929 or dial 7-1-1
Phone hours: Monday–Sunday 8:00 a.m. to 8:00 p.m.
Office hours: Monday–Friday 8:00 a.m. to 4:00 p.m.
Email: CustomerSupport@hpsm.org
Grievance and Appeals Unit
Toll free: 1-888-576-7227
Local: 650-616-2850
Fax 650-829-2002
Monday–Friday 8:00 a.m. to 5:00 p.m.
Visit Us in Person
Health Plan of San Mateo
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080 - map
Hours are
8:00 a.m. to 4:00 p.m. Monday though Friday
Members can drop by our office to speak with a Member Services Representative in-person. No appointment is necessary. To help us better assist you, bring your Member ID card with you. Visitors only need to wear masks during private appointments. We have masks on hand for those who do not have them. Other health and safety precautions are in place as well. Our office is ADA-compliant and wheelchair accessible.
For more information about visiting HPSM’s office, call the HPSM Reception Desk at 650-616-0050.
Policy & Procedures
To get a copy of HPSM’s Grievance and Appeals Policy and Procedures call the Grievance and Appeals Unit at 1-888-576-7227 or 650-616-2850.
File a Complaint
If you are dissatisfied with your medical care or the service provided by HPSM or your doctor's office, we want to address and resolve it to your satisfaction. Our grievance and appeals process allows us to do this as quickly as possible.
Expressing concerns or filing a complaint will not affect your benefits in any way. Your provider (doctor) also cannot discriminate against you because you file a complaint.
How to file a complaint
First, call us
We will try to resolve your concern over the phone. If we do not resolve your complaint to your satisfaction within 24 hours, the Grievance and Appeals Unit will start a formal process to reach a solution.
- CareAdvantage members: Call the CareAdvantage Unit at 1-866-880-0606 (toll-free) or 650-616-2174
- Medi-Cal members, HealthWorx members and San Mateo County ACE participants: Call Member Services at 1-800-750-4776 (toll-free) or 650-616-2133
- Medi-Cal members, if your problem or complaint is about a pharmacy or drug issue, you will need to file it with Medi-Cal Rx directly.
Grievance and Appeals
There are two types of complaints:
- File a grievance if you are dissatisfied about the medical services or customer service you received from HPSM or a provider
- File an appeal if you want HPSM to reconsider a decision to deny coverage for a service or item you or your doctor requested
There are four ways you can file a grievance
- Online: Fill out and submit HPSM's online complaint form.
- Medi-Cal members, if your problem or complaint is about a pharmacy or drug issue, you will need to file it with Medi-Cal Rx directly.
- By phone:
- CareAdvantage members: Call the CareAdvantage Unit at 1-866-880-0606 (toll-free) or 650-616-2174
- Medi-Cal members, HealthWorx members and San Mateo County ACE participants: Call Member Services at 1-800-750-4776 (toll-free) or 650-616-2133
- In writing: Download and complete HPSM's printable Confidential Member Complaint Form,
then fax it to 650-829-2002 or mail it to:
- Health Plan of San Mateo
- Attn: Grievance and Appeals Unit
- 801 Gateway Boulevard, Suite 100
- South San Francisco, CA 94080
You can file an appeal by calling HPSM
- CareAdvantage members: Call the CareAdvantage Unit at 1-866-880-0606 (toll-free) or 650-616-2174
- Medi-Cal members, HealthWorx members and San Mateo County ACE participants: Call Member Services at 1-800-750-4776 (toll-free) or 650-616-2133
- Medi-Cal members, if your appeal is about a pharmacy or drug issue, you will need to file it with Medi-Cal Rx directly.
Complaints about emergency situations
If your complaint involves an imminent and serious threat to your health (including but not limited to severe pain, potential loss of life, limb or major bodily function), you or your provider may request an expedited (fast-tracked) review. If your complaint qualifies, we will resolve it within three days of receipt.
After you file a complaint
Within five business days of receiving your complaint, an HPSM Grievance and Appeals Coordinator will call you to discuss your complaint and review HPSM's complaint process. We will resolve your complaint within 30 days and send you a letter explaining our decision. To ask about the status of an existing complaint, call our Grievance and Appeals Unit.
Any services that were authorized will continue to be provided until your complaint is resolved.
Kaiser PCPs
If your PCP is with the Kaiser Foundation Health Plan then you must file your complaint with Kaiser. For information, call 1-800-464-4000 or 1-800-777-1370.
* If you receive prenatal care or pediatric care through the Kaiser Permanente Redwood City Medical Center, then follow HPSM’s usual complaints procedure.