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Home > ComplaintStats-2014-DHCS

Complaints Reported by the Department of Health Care Services for 2014

The California Department of Health Care Services oversees the Medi-Cal program. State Fair Hearings conducted by the Department of Social Services are an avenue for Medi-Cal applicants and members to address complaints about the program. 

The following table outlines State Fair Hearings reported by the Department of Health Care Services for OPA's Baseline Complaint Data Report.

2014 State Fair Hearings on Medi-Cal
(conducted by the Department of Social Services)
Most Common Reasons for Hearings in 2014 Managed Care:
  • Quality of care (91%)
  • Provider billing or reimbursement issues (5%)
  • Dis-enrollment and enrollment issues (2%)
  • Access to care (1%)
  • Other issues (1%)
Dental:
  • Unknown dental issue (50%)
  • Dental scope of benefits (48%) - This category includes access to care, quality of care, and service denial issues
  • Claim denial (2%)
  • Other issues (less than 1%)
Mental health:
Of the 14 mental health complaints, the most common reason was denial of specialty mental health services by mental health plan.
Most Common Results from Hearings in 2014 Managed Care: 
  • Complaint withdrawn (34%)
  • No action required (25%)
  • Health plan position upheld (22%)
  • Health plan position overturned (18%)
  • Other results (1%)
Dental:
  • Complaint withdrawn (49%)
  • Health plan position upheld (32%)
  • No action required (15%)
  • Health plan position overturned (4%)
Mental health:
Of the 14 mental health complaint results, the most common result was health plan position upheld.
Number of Days the Hearing Process Took in 2014 Between 12-150 days

 


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