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. The information on this page is based on annual data reported by DMHC to CDII.
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 data DMHC reported about its consumer assistance in 2021.
Consumer assistance volume
130,197 phone calls, emails, and other consumer contacts
Complaint volume
16,025 complaints
Complaint review time
26 days on average, with complaint resolution times ranging from 0-454 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
- Medical Necessity Denial (15% of complaints)
- Co-Pay, Deductible, and Co-Insurance Issues (13%)
- Delays/No Response (9%)
- Denial of Coverage (8%)
- Quality of Care (7%)
- Out-of-Network Benefits (7%)
- Misrepresentation (6%)
- Billing/Reimbursement Issue (5%)
- Access to Care (5%)
- Provider Attitude and Service (3%)
Top five results of the complaint review
- Health Plan Position Substantiated (35% of complaints)
- Compromise Settlement/Resolution (27%)
- Advised Complainant (17%)
- No Jurisdiction (8%)
- Health Plan Position Overturned (6%)
More Information
Center for Data Insights and Innovation
1215 O Street
Sacramento, CA 95814