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Home > Health Plan Problems? > Common problems

Common Problems  

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You can file a complaint if you have any problem related to your care or a service. You can file a complaint with your health plan by letter or e-mail, over the phone, or on your plan's website. 

 

 

Examples of common problems

  • You were denied a service, treatment, or medicine.
  • You cannot get an appointment as soon as you need it.
  • You were told a service or treatment was not medically necessary.
  • You cannot get a referral you need.
  • Your health plan cancelled your coverage.
  • Your plan will not pay you back for a covered service that you paid for.
  • You were billed for services you think should be paid by your coverage.
  • You got a bill from a provider who is in your plan's network, other than a bill for your co-pay or co-insurance.
  • Your plan will not pay for emergency care you received.
  • You think you received poor care or service.

Tips on how to file a complaint

  • When you call your health plan, state clearly that you want to file a complaint. Then explain the problem.
  • Your plan must usually give you a decision within 30 days, or within 3 days if your health problem is urgent.
  • You must file your complaint within 6 months after the incident or action that is the cause of your problem.
  • Have the information you need ready when you file a complaint, such as:
    • Your health plan membership number.
    • A short description of your problem.
    • Why you need this benefit or service.
    • The date the problem happened or started.
    • If you feel the problem is urgent and why.

 

Complaints filed against health plans

The Department of Managed Health Care operates a Help Center to assist HMO plan members with problems with their plan. Learn more about the complaints filed by HMO plan members...

 

Health Plan Problems?

Call 1-888-466-2219

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