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

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 2016.

Department of Managed Health Care
Service Center Name Help Center
Website www.healthhelp.ca.gov
Main Phone Number 1-888-466-2219
TTY/TDD 1-877-688-9891
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
  1. Cancellation (18%)
  2. Experimental / Investigational Denial (17%)
  3. Medical Necessity Denial (14%)
  4. Co-Pay, Deductible, and Co-Insurance Issues (11%)
  5. Coverage Question (7%)
  6. Provider Attitude and Service (5%)
  7. Out of Network Benefits (5%)
  8. Other Violation of Insurance Law / Regulation (4%)
  9. Disenrollment / Enrollment Issues (4%)
  10. Pharmacy Benefits (3%)
Most Common Results from this Service Center's Complaint Review
  1. Health plan position upheld (34%)
  2. Consumer Received Requested Service (17%)
  3. Insufficient Information (16%)
  4. Compromise Settlement / Resolution (12%)
  5. Health plan position overturned (11%)
  6. Referred to other division for possible disciplinary action (10%)
  7. Other results (1%)
Average Number of Days a Complaint Review Takes 28 days
Minimum number of days to resolve a complaint: 0 days
Maximum number of days to resolve a complaint: 1,298 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

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