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​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 about certain PPO health plans and other 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)
TTY/TDD: 1-800-482-4833

Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. to reach a Compliance Officer.
Also offers an after-hours virtual assistant and 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 OPA about its health care-related consumer assistance volumes and complaint cases it reviewed in 2023.

Consumer assistance volume

26,414 phone calls and other requests for assistance from consumers on health care issues

Complaint volume

3,478 jurisdictional cases

Complaint review time

41 days on average for jurisdictional cases, with complaint resolution times ranging from 0-301 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 (28% of complaints)
  2. Information Requested (9%)
  3. Unsatisfactory Settlement/Offer (6%)
  4. Claim Delay (6%)
  5. Medical Necessity Denial (6%)
  6. Out-of-Network Benefits (5%)
  7. Co-Pay, Deductible, and Co-Insurance Issues (5%)
  8. Pharmacy Benefits (3%)
  9. Unsatisfactory Refund of Premium (2%)
  10. Authorization Dispute (2%)

Top ten results of the complaint review

  1. Upheld/Health Plan Position Substantiated (23% of complaints)
  2. Insufficient Information (22%)
  3. Information Furnished/Expanded (22%)
  4. Health Plan Position Overturned (13%)
  5. Claim Settled (9%)​
  6. Question of Fact/Contract/Provision/Legal Issue (3%)
  7. No Action Requested/Required (3%)
  8. Referred to Other Division for Possible Disciplinary Action (2%)
  9. Complaint Withdrawn (2%)
  10. Compromise Settlement/Resolution (2%)

More Information

Center for Data Insights and Innovation
1215 O Street
Sacramento, CA 95814