California

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. By California law, complaints must be resolved within 30 days. Follow the steps below to file a complaint and appeal with your health plan:

• Call the member/customer service phone number for your health plan.
• Tell them you want to file a formal complaint and then explain the problem.
• You can also file your complaint by letter, email, or online through your health plan’s website (see below).
• If you disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms of California‘s top health plans:

• Anthem Blue Cross of California
• Assurant Health
• Blue Shield of California
• Chinese Community Health
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina (Covered California)
• Molina (Medi-Cal)
• Molina (Medicare)
• Molina (Medicare-Medicaid Plan)
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage
• My plan isn’t listed

 

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the California Department of Managed Health Care (DMHC) and the California Department of Insurance (DOI) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first complete your health plan’s appeal process.

Depending on your coverage, you may need to file your complaint with the DMHC, the DOI or both. Call the DOI to determine which agency handles your health plan: (800) 927-4357.

• File a complaint with the DMHC and submit an Independent Medical Review application here or call the DMHC helpline: (888) 466-2219.
• File a complaint with the Department of Insurance here.