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Home > Complaint Data Reports > State Service Center Profiles > Profile-CDI

Consumer Assistance at 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 its consumer assistance service center and the complaint cases it reviewed in 2015.

California Department of Insurance
Service Center Name Consumer Services Division
Website www.insurance.ca.gov
Main Phone Number 1-800-927-HELP (4357) or 213-897-8921
TTY/TDD 1-800-482-4833
Hours of Operation Monday-Friday, 8:00 a.m. - 6:00 p.m.
After-hours message center 
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.

View complaint statistics from prior years for CDI

More resources

Department of Insurance online complaint and IMR application forms

OPA Complaint Data Reports

 

List of consumer assistance helplines

Tips on how to file a complaint