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Home > Complaint Data Reports > Statewide Data Highlights

Statewide Complaint Data Highlights

The statewide complaint information on this page is based on health care consumer assistance data collected for OPA's Annual Complaint Data Report for Measurement Year 2015.

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

2015 Statewide Complaint and Consumer Assistance Data
Total Complaint Volume 33,836 consumer health care coverage complaints reviewed and closed by state programs
Total Consumer Assistance Volume  7,077,594 phone calls, emails, and other consumer contacts to state service centers
Top 10 Statewide Complaint Reasons
  1. Medical necessity denial (12%)
  2. Denial of coverage (12%)
  3. Cancellation (10%)
  4. Pharmacy benefits (8%)
  5. Co-pay, deductible, and co-insurance issues (7%)
  6. Dis-enrollment or enrollment issue (6%)
  7. Claim denial (5%)
  8. Out-of-network benefits (4%)
  9. Coverage question (4%)
  10. Quality of care (4%)
Top 10 Results from State Complaint Reviews
  1. Health plan position upheld (28%)
  2. Complaint withdrawn (15%)
  3. Compromise settlement or resolution (12%)
  4. Insufficient information for further investigation (10%)
  5. Health plan position overturned (8%)
  6. Consumer received requested service (6%)
  7. No action requested or required (6%)
  8. Referred to other division for possible disciplinary action (4%)
  9. Health plan in compliance (3%)
  10. Recovery (3%)
Number of Days a State Complaint Review Usually Takes Averages 55 days 

Ranges between 0-200 days statewide. 

  • DMHC 6-56 days (includes time prior to the completion of a complaint application when the consumer first contacted the department)
  • DHCS 0-200 days
  • CDI 68-95 days (includes time for regulatory review after complaint is closed to the consumer)
  • Covered California 49-69 days 

More resources

OPA Complaint Data Reports

List of consumer assistance helplines

Tips on how to file a complaint