Medi-Cal behavioral health appeal checklist
A printable from Medi-Cal Behavioral Health Appeal. Fill it in by hand. Nothing you write is collected by this website.
Medi-Cal behavioral health appeal checklist
- Date on my denial letter: ________. My 60 day deadline: ________
- Is my care being cut or stopped? If yes, my 10 day date: ________
- I said "I want to keep getting my services while I appeal"
- Is it urgent? I asked for a fast (expedited) appeal and said why
- Who is filing: me, or my helper: ________ (signed permission given)
- Note from my counselor, doctor or program attached (copy)
- I called on ________ and spoke with ________
- I sent a written appeal on ________ and kept a copy
- County appeal decision date: ________. My 120 day State Hearing deadline: ________
- Free help: Health Consumer Alliance 888-804-3536
San Mateo County OCFA: (800) 388-5189. Santa Clara County Member Rights: (800) 704-0900 or (408) 793-5894. State Hearings: (800) 743-8525.
In a crisis, call or text 988. If someone is in danger, call 911.
From Medi-Cal Behavioral Health Appeal. Facts checked October 21, 2026. Free information, not legal or medical advice.