The Help Center is a part of the Department of Managed Health Care (DMHC). The DMHC oversees HMOs and some other health plans in California.
The Help Center can help you with your complaint. We can also give you an Independent Medical Review if you qualify.
File a Complaint with the Help Center If:
- Your problem is urgent and waiting to finish your health plan's complaint (grievance) process will be a serious risk to your health.
- You have not received a decision from your health plan within 30 days, or within 3 days if your problem is urgent.
- You are not satisfied with your health plan's decision.
How to File a Complaint with the Help Center
- To file an urgent complaint, call the Help Center.
- To file a complaint that is not urgent, fill out and mail a Complaint Form.
There is no charge for your call.
The Help Center can help in many languages.
For email questions, please use the Contact Form
Questions and Answers
Can I still take legal action if I file a complaint?
Yes. You can take legal action at any time during the complaint process.
- In some health plans, you must use arbitration. This is a way to solve problems between plans and patients without a lawsuit. In arbitration, an independent person or several people settle the dispute. Check your Evidence of Coverage, which is your contract with your plan.
- In some cases, you may have to ask for an Independent Medical Review before you can take legal action.
- You may also want to speak with a private attorney.
Does the Help Center act as my attorney?
No. The Help Center does not give legal advice or act as your attorney. We will review your complaint and let you know if your health plan has followed the law.
How will my complaint be decided?
The Help Center will send you and your health plan a letter that explains our decision. If the complaint is decided in your favor, we will require your health plan to provide or pay for the service, or do whatever is needed to resolve the complaint. If the complaint is not decided in your favor, you cannot appeal the decision. However, you can still take legal action.