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 (HELP)
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)
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 2020. More details can be found in the CDI section of the full Annual Complaint Data Report.
Consumer assistance volume in 2020: 28,070 phone calls and other contacts from consumers on health care issues
Complaint volume in 2020: 3,217 jurisdictional cases
Complaint review time in 2020:
64 days on average for jurisdictional cases
Complaint resolution times ranged from 0-570 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:
- Claim Denial (34% of complaints)
- Out-of-Network Benefits (8%)
- Unsatisfactory Settlement/Offer (7%)
- Medical Necessity Denial (7%)
- Emergency Services (5%)
- Claim Delay (4%)
- Co-Pay, Deductible, and Co-Insurance Issues (3%)
- Authorization Dispute (3%)
- Pharmacy Benefits (3%)
- Unsatisfactory Refund of Premium (2%)
Top five results of the complaint review:
- Health Plan Position Substantiated (34% of complaints)
- Insufficient Information (22%)
- Health Plan Position Overturned (22%)
- Claim Settled (11%)
- No Action Requested/Required (3%)