HMO Complaints
This page describes what to do if you have an HMO or a Blue Cross/Blue Shield PPO.
Topics on this page
How to file a complaint with your plan
- File a complaint in writing, over the phone, or on your plan’s website. The phone number is on your membership card.
- Your plan must give you a decision within 30 days, or in three days if your problem is urgent.
- If you are not satisfied with your plan’s decision, or the plan does not meet the deadline for responding, contact the Help Center.
- Use the My Complaint worksheet to keep track of your complaint.
How to file a complaint with the state
- Contact the Help Center.
- If they decide in your favor, your health plan must provide the service.
Request an Independent Medical Review (IMR)
- An IMR is a review of your plan’s denial of medical treatment. Doctors who are not part of your plan make an independent decision about the denial.
- The plan must do what the IMR decides.
- More information on IMR.
Urgent problems
- If your problem is urgent, contact the Help Center directly.
- If your plan denies a service because it is experimental or investigational, contact the Help Center directly.
- If your plan cancels your coverage, contact the Help Center directly.
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