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Home > Complaint Stats-2015-DMHC

Complaints Reviewed in 2015 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 2015.

Department of Managed Health Care - 2015 Help Center Statistics
Most Common Reasons for Complaints Filed with this Service Center
  • Medical necessity denial (20%)
  • Cancellation (14%)
  • Co-pay, deductible, and co-insurance issues (13%)
  • Coverage question (7%)
  • Out-of-network benefits (7%)
  • Provider attitude and service (6%)
  • Dis-enrollment and enrollment issues (6%)
  • Experimental / investigational denial (5%)
  • Pharmacy benefits (4%)
  • Access to care (3%)
Most Common Results from this Service Center's Complaint Review
  • Health plan position upheld (38%)
  • Insufficient information for further investigation (17%)
  • Compromise settlement or resolution (17%)
  • Consumer received requested service (12%)
  • Health plan position overturned (9%)
  • Referred to other division for possible disciplinary action (7%)
  • Other results (1%)
Number of Days a Complaint Review Usually Takes Between 6-56 days

  • There is a faster review process for an urgent health issue.
  • The review time takes longer if the complaint application is missing information. If you are filing a complaint, be sure to fill in the complaint application form completely and promptly respond to any follow-up questions the Help Center staff may have.
  • 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.

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