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Home > Complaint Stats-2014-DMHC

Complaints Reviewed in 2014 by the Department of Managed Health Care

The Department of Managed Health Care is a state regulator that oversees most Californians' health care coverage.

The following table outlines information the department reported to OPA about the health care complaint cases its Help Center reviewed in 2014.

Department of Managed Health Care - 2014 Help Center Statistics
Most Common Reasons for Complaints Reviewed in 2014
  • Medical necessity denial (17%)
  • Co-pay, deductible, and co-insurance issues (13%)
  • Dis-enrollment and enrollment issues (11%)
  • Coverage question (9%)
  • Cancellation (8%)
  • Out-of-network benefits (7%)
  • Access to care (6%)
  • Provider attitude and service (5%)
  • Experimental / investigational denial (4%)
  • Pharmacy benefits (3%)
Most Common Results from this Service Center's Complaint Review in 2014 Most complaints filed with the Help Center are resolved in favor of the consumer.

  • Compromise resolution (45%)
  • Insufficient information for further investigation (19%)
  • Complaint withdrawn (12%)
  • Claim settled (11%)
  • Health plan position upheld (6%)
  • Health plan position overturned (4%)
  • Other results (3%)
Number of Days a Complaint Review Took in 2014 Between 6-37 days

 

  • The time frame noted above includes resolution times counted from the date that any initial information was received from a consumer prior to the completion of the complaint application.