Can I complain about my doctor, dentist, health plan, or behavioral health
Health plan members, also known as enrollees should file a complaint (also
known as an appeal or grievance) if you have a problem with your health plan. To
do so, first contact your health plan to file a complaint. You can file a
complaint with your health plan over the phone or in writing. You may also be
able to file a complaint on your health plan's website.
If your health problem is urgent, if you
already filed a complaint with your health plan and are not satisfied with the
decision, or it has been more than 30 days since you filed a complaint with your
health plan you may submit an Independent Medical Review Application/Complaint
Form with the DMHC. If you need assistance you may contact the Help Center at
Enrollees can file a Consumer Complaint with
the DMHC for complaint issues such as balance billing, billing for
services that your health plan states is not a covered benefit, if you have a
dispute on the amount paid on a claim, a co-pay dispute, cancellation of your
coverage or if you have a complaint about the provider’s attitude.
Enrollees can also apply for an Independent
Medical Review (IMR) with the DMHC when a health care service or treatment has
been denied, modified or delayed. An IMR is a review of your case by independent
doctors who are not part of your health plan. You have a good chance of
receiving the service or treatment you need by requesting an IMR. If the IMR is
decided in your favor, your plan must authorize the service or treatment you
requested. IMR’s are free to enrollees.
If you believe that you are not being treated fairly, you have the right to
talk about your concerns. Health plans are required by law to have
a grievance process in place to resolve enrollee complaints within 30 days. In
most circumstances, you are required to file a grievance regarding each
issue/request with your health plan and participate in the process for 30 days
before submitting a complaint to the Department of Managed Health Care (DMHC).
Exceptions to this requirement include when there is an immediate threat to your
health or the request was denied as experimental. In either of these instances,
you may seek immediate assistance from the DMHC at 1(888) 466-2219.
You may submit a complaint online with the California Department of Managed
File a Complaint Here
To file a Mental Health specific complaint contact the Mental Health
Oversight and Accountability Commission:
File a Behavioral
Health Complaint Here