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

Consumer Assistance at the Department of Health Care Services

The Department of Health Care Services administers Medi-Cal and other programs that provide medical and other services and support to Californians with a low income or disability.

The following tables outline information the department reported to OPA about its consumer assistance service centers.

Medi-Cal Managed Care Office of the Ombudsman
Website www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx
Main Phone Number 1-888-452-8609
TTY/TDD 1-800-896-2512
Hours of Operation Monday-Friday, 8:00 a.m. - 5:00 p.m.
(except state holidays)
Most Common Reasons for Complaints Filed with this Service Center This service center provides education and referrals only 
Learn more about Medi-Cal complaints

 

Medi-Cal Telephone Service Center (Contractor: Xerox)
Website www.medi-cal.ca.gov
Main Phone Number 1-800-541-5555
TTY/TDD 916-635-6491
Hours of Operation Monday-Friday, 8:00 a.m. - 5:00 p.m.
Most Common Reasons for Complaints Filed with this Service Center This service center provides education and referrals only 
Learn more about Medi-Cal complaints

 

Denti-Cal Beneficiary Telephone Service Center (Contractor: Delta Dental)
Website www.denti-cal.ca.gov
Main Phone Number 1-800-322-6384
TTY/TDD 1-800-735-2922
Hours of Operation Monday-Friday, 8:00 a.m. - 5:00 p.m.
Some automated services available through the phone system 7 days a week, 24 hours a day 
Most Common Reasons for Complaints Filed with this Service Center This service center provides education and referrals only 
Learn more about Medi-Cal complaints

 

Complaints Reported for 2016

The California Department of Health Care Services oversees the Medi-Cal program. State Fair Hearings conducted by the Department of Social Services are an avenue for Medi-Cal applicants and members to address complaints about the program.

The following table outlines State Fair Hearings reported by the Department of Health Care Services for OPA's annual Complaint Data Report.

2016 State Fair Hearings on Medi-Cal
(conducted by the Department of Social Services)
Most Common Reasons for Hearings in 2016 Medi-Cal (Managed Care and Fee for Service):
  1. Disenrollment and Enrollment Issues (23%)
  2. Medical Necessity Denial (20%)
  3. Claim Denial (18%)
  4. Pharmacy Benefits (12%)
  5. Quality of Care (12%)
Dental:
  1. Scope of Benefits (54%)
  2. Medical Necessity Denial (40%)
  3. Claim Denial (5%)
Mental health:
  1. Denied Services (20%)
  2. Medical Necessity Denial (18%)
  3. Unknown (15%)​
  4. Provider Availability / Timely Access to Care (8%)
  5. Waiting Periods (6%)
Most Common Results from Hearings in 2016
  1. Complaint Withdrawn (44%)
  2. Health Plan Position Upheld (28%)
  3. No Action Required (19%)
  4. Health Plan Position Overturned (5%)
  5. Other Results (4%)
Average Number of Days the Hearing Process Took in 2016 80 days
Minimum number of days: 0
Maximum number of days: 411


Find complaint information from prior years

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