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...