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​Consumer Assistance at the Department of Managed Health Care

The Department of Managed Health Care (DMHC) is a state regulator that oversees most Californians’ health care coverage. Its Help Center addresses complaints from members of HMOs and other health plans licensed by the department.

DMHC Help Center

Main phone number: 1-888-466-2219
TTY/TDD: 1-877-688-9891

Hours of operation: Monday-Friday, 8:00 a.m. – 6:00 p.m.
Service for urgent issues available after hours and on state holidays.

Website: www.healthhelp.ca.gov

Complaint Data Highlights

The highlights below are based on information DMHC reported to OPA about its consumer assistance service center and the complaint cases it reviewed in 2018. More details can be found in the DMHC section of the full Annual Complaint Data Report.

Consumer assistance volume in 2019: 138,804 phone calls, emails, and other consumer contacts

Complaint volume in 2019: 15,915 complaints

Complaint review time in 2019: 21 days on average

Complaint resolution times ranged from 0-186 days.

  • The above statistics include cases with review times counted prior to completion of the complaint application, when initial information was first received from the consumer. DMHC’s time standard for its review of standard complaints is 30 days after receipt of a complete complaint application.
  • DMHC usually requires that consumers file a complaint (grievance) with their health plan before the department will review their complaint.
  • There is a faster process for urgent health issues.

Top ten reasons for complaints:

  1. Co-Pay, Deductible, and Co-Insurance Issues (19% of complaints)
  2. Medical Necessity Denial (14%)
  3. Quality of Care (8%)
  4. Out-of-Network Benefits (7%)
  5. Delays/No Response (7%)
  6. Denial of Coverage (6%)
  7. Misrepresentation (6%)
  8. Access to Care (5%)
  9. Cancellation (4%)
  10. Experimental (4%)

Top five results of the complaint review:

  1. Health Plan Position Substantiated (45% of complaints)
  2. Compromise Settlement/Resolution (16%)
  3. Advised Complainant (12%)
  4. No Jurisdiction (9%)
  5. Health Plan Position Overturned (7%)