Complaints to the Department of Managed Health Care
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 the plan at (209) 942-6330, or
toll-free at 1-888-318-PLAN (7526) and use your 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 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-HMO-2219) and a TDD line
(1-877-688-9891) for the hearing and speech impaired.
The Department’s Internet website
(http://www.hmohelp.ca.gov) has complaint forms,
IMR application forms and instructions online.
