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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 2016.

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.

2016 Statewide Complaint and Consumer Assistance Data
Total Complaint Volume 55,923 consumer health care coverage complaints reviewed and closed by state programs
Total Consumer Assistance Volume  7,644,780 phone calls, emails, and other consumer contacts to state service centers
Top 10 Statewide Complaint Reasons
  1. Denial of Coverage (23%)
  2. Cancellation (14%)
  3. Medical Necessity Denial (10%)
  4. Experimental/Investigational Denial (9%)
  5. Eligibility Determination (7%)
  6. Co-Pay, Deductible, and Co-Insurance Issues (5%)
  7. Claim Denial (4%)
  8. Dis-Enrollment or Enrollment Issues (4%)
  9. Coverage Question (3%)
  10. Pharmacy Benefits (3%)
Top 10 Results from State Complaint Reviews
  1. Health Plan Position Upheld (24%)
  2. Withdrawn/Complaint Withdrawn (18%)
  3. Compromise Settlement/Resolution (13%)
  4. Health Plan Position Overturned (11%)
  5. Consumer Received Requested Service (9%)
  6. No Action Requested/Required (8%)
  7. Insufficient Information (8%)
  8. Referred to Other Division for Possible Disciplinary Action (5%)
  9. Recovery (1%)
  10. Question of Fact/Contract/Provision/Legal Issue (1%)
Number of Days a State Complaint Review Usually Takes Averages 51 days

Ranges between 0-1,298 days statewide.

  • DMHC 0-1,298 days (28 days average; includes time prior to the completion of a complaint application when the consumer first contacted the department)
  • DHCS 0-411 days (80 days average)
  • CDI 0-669 days (90 days average; includes time for regulatory review after complaint is closed to the consumer)
  • Covered California 0-226 days (66 days average)

Data from Prior Years

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