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Home > Complaint Stats-2015-CDI

Complaints Reviewed in 2015 by the California Department of Insurance

The California Department of Insurance is one of the state regulators that oversees Californians' health care coverage. 

The following table outlines information the department reported to OPA about the health care complaint cases it reviewed in 2015.

California Department of Insurance - 2015 Statistics
Most Common Reasons for Complaints Filed with this Service Center
  • Claim denial (29%)
  • Unsatisfactory settlement or offer (10%)
  • Medical necessity denial (9%)
  • Out-of-network benefits issue (7%)
  • Co-pay, deductible, and co-insurance issues (5%)
  • Experimental (4%)
  • Pharmacy benefits (4%)
  • Claim delay (4%)
  • Emergency services (3%)
  • Preventive care (2%)
Most Common Results from this Service Center's Complaint Review  
  • Health plan position substantiated (21%)
  • Recovery (20%)
  • Health plan in compliance (15%)
  • Question of fact / contract / provision / legal issue (12%)
  • Question of fact (9%)
  • Advised complainant (8%)
  • Additional payment (4%)
  • Claim settled (3%)
  • Compromise settlement or resolution (2%)
  • Policy issued or restored (2%)
Number of Days a Complaint Review Usually Takes Between 68-95 days

  • There is a faster review process for an urgent health issue.
  • The time frame noted above includes time for regulatory review after the case is closed to the consumer who filed the complaint. CDI indicated that this final regulatory review period is 30 days on average.


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