Consumer Assistance at 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 its consumer assistance service center and the complaint cases it reviewed in 2015.
|Department of Managed Health Care|
|Service Center Name
|Main Phone Number
|Hours of Operation
||Monday-Friday, 8:00 a.m. - 6:00 p.m. |
Service for urgent issues available after hours and on state holidays
|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.
Find complaint information from prior years for the Department of Managed Health Care
Department of Managed Health Care complaint application form
Tips on how to file a complaint
OPA Complaint Data Reports
List of consumer assistance helplines