If you have a complaint about Atlas Managed Care, such as the way you were treated, a service you received, a determination on your case, or our privacy practices, this page tells you exactly how to raise it, what we'll do about it, and where else you can go for help.
1. Our Commitment
Atlas Managed Care takes every complaint seriously. We commit to:
- Acknowledge every complaint promptly.
- Investigate fairly and thoroughly.
- Respond in writing within defined time frames.
- Never retaliate against you for raising a concern.
- Track and trend complaints to improve our services.
Our complaint process aligns with URAC consumer-complaint standards (Workers' Compensation Utilization Management Standard CPE 2-3) and California Division of Workers' Compensation ("DWC") expectations under California Labor Code § 4610 and 8 CCR §§ 9792.6 – 9792.9.5.
2. Types of Complaints We Handle
2.1 Service Complaints
Concerns about how you were treated by an Atlas representative, response times, communication, professionalism, or access to services.
2.2 Utilization Review Complaints
Concerns about the conduct of a utilization review, the timeliness of a determination, the qualifications of a reviewer, or the process by which a determination was made. Note: utilization review determinations themselves (approval, modification, or denial of treatment) are subject to a separate appeal and Independent Medical Review process under California Labor Code § 4610.5. See Section 6.
2.3 Privacy Complaints
Concerns about how Atlas has used or disclosed your Protected Health Information ("PHI"). See our HIPAA Notice of Privacy Practices for the full process.
2.4 Accessibility Complaints
Concerns about the accessibility of our website, our phone systems, or our written communications under the Americans with Disabilities Act ("ADA") and California Government Code § 11135. See our Accessibility Statement.
2.5 SMS / Communication Complaints
Concerns about SMS messages received from Atlas. See our SMS Communication & Consent Policy for opt-out procedures.
3. How to File a Complaint With Atlas
You may file a complaint by any of the following methods. There is no fee to file a complaint, and you may file in English or Spanish. We will provide language assistance at no cost if you need it.
By phone: 1-877-828-5276 (Mon–Fri 8:00 AM – 5:00 PM Pacific Time)
By email: complaints@atlasmanagedcare.com
By mail: Atlas Managed Care, Attn: Complaints & Grievances Coordinator
3400 Cottage Way, Ste. G2 #34605, Sacramento, CA 95825
For privacy complaints specifically: privacy@atlasmanagedcare.com
What to include in your complaint: your name and contact information, your claim or case number (if known), the date(s) of the events, the names of any Atlas representatives involved, a description of what happened, and what outcome you are seeking. If you cannot or do not wish to provide all this information, we will still review your complaint.
4. What Happens After You File
- Acknowledgment within 5 business days. We confirm receipt of your complaint in writing (email, letter, or both, per your preference), assign it a tracking number, and identify the staff member responsible for investigating.
- Investigation within 30 calendar days. The assigned investigator reviews the relevant records, interviews involved staff, and consults with our Compliance Officer or Privacy Officer as appropriate. Expedited investigation (within 72 hours) is available where there is a serious, imminent threat to health or safety.
- Written resolution within 30 calendar days of acknowledgment. You will receive a written response explaining the findings of our investigation, any corrective action taken, and your right to seek further review (Section 5 and Section 6 below). If we need additional time, we will notify you in writing and provide an updated expected response date, not to exceed an additional 30 calendar days.
- Tracking and trending. Every complaint is logged in our Complaints Register and reviewed in our quarterly Quality Improvement meetings. Trends inform corrective action and training.
5. If You Are Not Satisfied With Our Response
If you are not satisfied with the resolution we provide, you may:
- Request escalation to our Compliance Officer for a second-level review by emailing compliance@atlasmanagedcare.com or by calling 1-877-828-5276 and asking for the Compliance Officer.
- File a complaint with our URAC-accredited utilization management partner, Arissa Cost Solutions, if your complaint concerns delegated utilization review activities. Atlas will forward your complaint to Arissa upon request.
- File a complaint with an outside regulator (Section 7).
6. Utilization Review: Separate Appeal and IMR Process
If your complaint concerns the substantive outcome of a utilization review determination (the decision to approve, modify, or deny requested treatment), California law provides a separate appeal and Independent Medical Review ("IMR") process. The complaint process on this page does not replace or extend the deadlines for that process.
- Utilization Review Appeals are administered under California Labor Code § 4610 and 8 CCR § 9792.10.
- Independent Medical Review is administered by the State of California's IMR program operated by Maximus Federal Services on behalf of the DWC. The IMR application form is included with every Notice of Utilization Review Determination that modifies or denies requested treatment.
- Deadlines: An IMR application must generally be filed within thirty (30) days of receipt of the utilization review determination.
For details, see the IMR information mailed with your determination letter, or contact the DWC Information and Assistance Unit (Section 7.1).
7. Outside Resources: Where Else You Can File
7.1 California DWC Information & Assistance Unit
The DWC Information & Assistance Unit provides free help to injured workers about their workers' compensation rights and procedures, including how to file a complaint about a UR organization, claims administrator, employer, or provider.
DWC Information & Assistance Unit
Toll-free: 1-800-736-7401 (24-hour recorded information)
Website: www.dir.ca.gov/dwc/iandapod.html
Office locations: www.dir.ca.gov/dwc/dir2.htm
7.2 California Division of Workers' Compensation: Audit Unit
The DWC Audit Unit investigates complaints against claims administrators, utilization review organizations, and self-insured employers.
DWC Audit Unit
160 Promenade Circle, Suite 340, Sacramento, CA 95834
Phone: 1-916-928-3193
Email: dwcaudit@dir.ca.gov
7.3 U.S. Department of Health and Human Services: Office for Civil Rights
For HIPAA privacy and security complaints.
HHS Office for Civil Rights
Toll-free: 1-800-368-1019 (TDD: 1-800-537-7697)
Online: www.hhs.gov/ocr/complaints/
7.4 URAC
URAC accepts consumer complaints about URAC-accredited organizations.
URAC
1220 L Street NW, Suite 400, Washington, DC 20005
Phone: 1-202-216-9010
Online: www.urac.org/file-a-grievance/
8. Non-Retaliation
Atlas will not retaliate against, intimidate, threaten, coerce, discriminate against, or take any other adverse action against any individual who in good faith files a complaint, participates in an investigation, or exercises any right under HIPAA, the California Labor Code, the ADA, or any other applicable law.
9. Records Retention
Atlas retains complaint records for a minimum of seven (7) years from the date of resolution, consistent with California Labor Code § 4610 and HIPAA 45 CFR § 164.316(b)(2)(i).
10. Contact
Atlas Managed Care: Complaints & Grievances Coordinator
3400 Cottage Way, Ste. G2 #34605
Sacramento, CA 95825
Phone: 1-877-828-5276 (Mon–Fri 8AM–5PM PT)
Email: complaints@atlasmanagedcare.com