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Home > Statewide Data Highlights - Measurement Year 2014

Statewide Complaint Data Highlights

Measurement Year 2014

The statewide complaint information on this page are based on health care consumer assistance data collected for OPA's annual Complaint Data Report for Measurement Year 2014.

The information displayed below combines 2014 data reported by the Department of Managed Health Care, Department of Health Care Services, California Department of Insurance, and Covered California.

2014 Statewide Complaint and Consumer Assistance Data
Total Complaint Volume 27,028 consumer health care coverage complaints reviewed and closed by state programs
Total Consumer Assistance Volume  5,947,873 phone calls, emails, and other consumer contacts to state service centers
Top 10 Statewide Complaint Reasons
  1. Claim denial (18%)
  2. Quality of care (11%)
  3. Medical necessity denial (10%)
  4. Co-pay, deductible, and co-insurance issues (7%)
  5. Disenrollment or enrollment issues (6%)
  6. Cancellation (6%)
  7. Coverage question (5%)
  8. Out-of-network benefits (4%)
  9. Access to care (3%)
  10. Provider attitude and service (3%)
Top 10 Results from State Complaint Reviews
  1. Compromise settlement or resolution (24%)
  2. Complaint withdrawn (19%)
  3. Health plan position upheld (14%)
  4. Insufficient information for further investigation (9%)
  5. Health plan position overturned (7%)
  6. Claim settled (6%)
  7. No action requested or required (6%)
  8. Consumer's money returned (3%)
  9. Question of fact, contract, or law falls outside regulator (3%)
  10. Health plan in compliance (2%)
Number of Days a State Complaint Review Usually Takes Averages 43 days 

Ranges between 6-157 days statewide. 

  • DMHC 6-37 days (includes time prior to the completion of a complaint application when the consumer first contacted the department)
  • DHCS 12-150 days
  • CDI 21-157 days (includes time for regulatory review after complaint is closed to the consumer)
  • Covered California 39-50 days 


Find statewide complaint data for other years...