HMO Complaints

The HMO Help Center

1-888-466-2219 (toll-free)
Call 24 hours a day
Help in many languages
Complaint form
Independent Medical Review form

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
• How to file a complaint with the state
• Request an Independent Medical Review (IMR)
• Urgent problems

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 HMO Help Center.
• Use the My Complaint worksheet to keep track of your complaint.

How to file a complaint with the state

• Contact the HMO 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 HMO Help Center directly.
• If your plan denies a service because it is experimental or investigational, contact the HMO Help Center directly.
• If your plan cancels your coverage, contact the HMO Help Center directly.

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