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Home > Health Plan Problems?

Problems and Complaints

To get help with a health care problem, you can contact the California Consumer Assistance Program. File a complaint online or call toll-free 1-888-466-2219.

Patients in California have many rights. If you are having trouble getting a health care service you need, there are people and programs that can help you. Read about common problems.  

Also learn how to avoid or report health insurance scams

You have the right to file a complaint if you have a problem getting the services you need. 

  •  First, start by filing a formal complaint with your health plan. A complaint is also called a grievance or appeal. Learn how to file a complaint.
  • If your health plan says no to your complaint, or does not reply in time, you can file an appeal with an outside agency. This is also called an Independent Medical Review or an external appeal.

California has state help centers and local programs that can help with complaints and appeals.

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Health Plans

Contact the Department of Managed Health Care for:

  • Help with problems with your health plan.
  • Referrals if you do not know where to get help with a health care problem.
  • Free help is offered in many languages.

1-888-466-2219

www.healthhelp.ca.gov

Insurance

Contact the California Department of Insurance for:

  • Help with many PPO plans.
  • Help with some other kinds of health insurance.

1-800-927-4357

www.insurance.ca.gov

 
 

Covered CA

Contact Covered California to:

  • Appeal a Covered California decision regarding your eligibility.
  • File a complaint about a problem related to Covered California.

1-800-300-1506
www.coveredca.com



For a problem with a health plan purchased through Covered California:

  • First, contact your plan's member services to file a complaint. The phone number is listed on your member card.
  • Second, you can contact the Department of Managed Health Care for help with most Covered California plans. Call 1-888-466-2219 or file an online complaint.

Medicare

Contact the Health Insurance Counseling and Advisory Program (HICAP) for:

  • Free help with questions, problems, or complaints about your Medicare coverage.

1-800-434-0222

Learn more about Medicare complaints...

For more information, visit www.medicare.gov.

 
 

Medi-Cal

  • If you have a question about eligibility or if you have regular (fee-for-service) Medi-Cal, contact your local county office.
  • If you are in a Medi-Cal Managed Care Plan, you can contact either the Medi-Cal Managed Care Ombudsman (1-888-452-8609) or the Department of Managed Health Care (1-888-466-2219) if you have a problem.
  • Find more information about Medi-Cal complaints, including information about Medi-Cal Fair Hearings.

 
 

Resources

DMHC Complaint Form / IMR Application

CDI Complaint and IMR Forms

DOL Request for Assistance

Medicare Complaint Form

Covered California Eligibility Appeals Form (PDF)

Covered California Complaint Form (PDF)​

Health Plan Problems?

Call 1-888-466-2219

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