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Home > Health Plan Problems? > How to File a Complaint > Tips for Communicating with your Plan

Tips for Communicating with Your Health Plan

Every health plan and insurer in California has a member/customer service phone number. You can call this number for general assistance and answers to your questions. You can also call this number to file a formal complaint about a problem.

  • Look on your membership card to find this number.
  • If there is no TTY, call the California Relay at 7-1-1.  You can also call 7-1-1 if you have a speech disability.

By calling your plan's member/customer service phone number, you can:

  • Ask questions about billing.
  • Get a copy of your Evidence of Coverage or summary of benefits. These documents explain your plan's benefits, costs, and rules.
  • Ask about health care outside of your plan's service area.
  • File a complaint.
  • Add or remove family member's from your plan.
  • Get a replacement copy of your membership card.
  • Tell your plan when your address or phone number changes.
  • Get help with access to care for people with disabilities.
  • Get help finding an interpreter for your health care.

 

Tips when talking to your plan

  • Act promptly and contact your plan's member/customer services.
    • Explain your problem briefly.
    • Ask for someone who can help you.
    • Then, explain your problem in more detail.
    • Make sure the person understands.
    • Ask for the person's name and direct phone number.
    • Ask what will happen next and how long it will take.
    • Ask for a reply in writing.
  • If you do not speak English, ask for someone who speaks your language.
  • Take notes on your calls. Write down the date and time of each call, the name of the person you spoke with, and a summary of what you each said.
  • Keep all of your notes and letters in one place.
  • If you feel you need additional support to help you speak up, have a friend, family member or someone else you trust with you during phone calls or meetings.
  • If you are denied care, ask for the reason in writing.
  • If you are denied a treatment or service, also ask your doctor for help. Your doctor may be able to help provide information to help you explain why you need a treatment. See more about Talking to your doctor.
  • Be persistent. Ask to speak to a supervisor if needed.

 

If talking to your health plan does not help

If talking to your HMO or PPO plan's customer service does not help, you have the right to file a formal complaint with your plan.  You can file this formal complaint with your plan by letter or e-mail, over the phone, or on your plan's website. Learn more about How to file a complaint.

  • State clearly that you want to file a complaint. Then explain the problem.
  • Your plan must give you a decision within 30 days, or within 3 days if your health problem is urgent.
  • You must file your complaint within 6 months after the incident or action that is the cause of the problem.   

 

Health Plan Problems?

Call 1-888-466-2219

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