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​Consumer Assistance at the California Department of Insurance

The California Department of Insurance (CDI) is one of the state regulators that oversees Californians’ health care coverage. Its Consumer Services Division addresses complaints from members of certain PPOs and other products from insurance companies licensed by the department. CDI also licenses insurance brokers and agents.

CDI Consumer Services Division

Main Phone Number: 1-800-927-4357
TTY/TDD: 1-800-482-4833

Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m.
After hours message center (calls returned by noon the next business day)

Website: www.insurance.ca.gov

Complaint Data Highlights

The highlights below are based on information CDI reported to OPA about its consumer assistance service center and the complaint cases it reviewed in 2019. More details can be found in the CDI section of the full Annual Complaint Data Report.

Consumer assistance volume in 2019: 37,628 phone calls and other contacts from consumers

Complaint volume in 2019: 4,619 jurisdictional cases

Complaint review time in 2019:

103 days on average for jurisdictional cases

Complaint resolution times ranged from 0-1,163 days.

  • The above statistics include case durations with time for CDI’s regulatory review after the case was closed to the consumer as well as re-opened cases with review times counted when the first complaint was filed by the consumer.
  • In addition, CDI complaint reviews may be concurrent with the health plan’s internal review period of a filed grievance.

Top ten reasons for complaints:

  1. Claim Denial (31% of complaints)
  2. Unsatisfactory Settlement/Offer (8%)
  3. Out-of-Network Benefits (7%)
  4. Medical Necessity Denial (7%)
  5. Rehabilitative/Habilitative Care (5%)
  6. Claim Delay (5%)
  7. Authorization Dispute (3%)
  8. Emergency Services (3%)
  9. Inadequate Reimbursement/Rates (2%)
  10. Co-Pay, Deductible, and Co-Insurance Issues (2%)

Top five results of the complaint review:

  1. Health Plan Position Substantiated (35% of complaints)
  2. Health Plan Position Overturned (20%)
  3. Insufficient Information (20%)
  4. Claim Settled (11%)
  5. Compromise Settlement/Resolution (7%)