​Consumer Assistance at the California Department of Insurance

CDI Consumer Services Division

Main Phone Number: 1-800-927-4357 (HELP)
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 the Center for Data Insights and Innovation about its health care-related consumer assistance volumes and complaint cases it reviewed in 2021.

Consumer assistance volume

23,455 phone calls and other contacts from consumers on health care issues

Complaint volume

3,608 jurisdictional cases

Complaint review time

46 days on average for jurisdictional cases, with complaint resolution times ranging from 0-783 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 (36% of complaints)
2. Unsatisfactory Settlement/Offer (8%)
3. Claim Delay (7%)
4. Information Requested (5%)
5. Out-of-Network Benefits (5%)
6. Medical Necessity Denial (5%)
7. Co-Pay, Deductible, and Co-Insurance Issues (3%)
8. Authorization Dispute (3%)
9. Unsatisfactory Refund of Premium (3%)
10. Emergency Services (3%)

Top five results of the complaint review

1. Insufficient Information (29%)
2. Health Plan Position Substantiated (22% of complaints)
3. Health Plan Position Overturned (15%)
4. Information Furnished/Expanded (14%)
5. Claim Settled (10%)​