​Consumer Assistance at the Department of Managed Health Care

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

1. Medical Necessity Denial (15% of complaints)
2. Co-Pay, Deductible, and Co-Insurance Issues (13%)
3. Delays/No Response (9%)
4. Denial of Coverage (8%)
5. Quality of Care (7%)
6. Out-of-Network Benefits (7%)
7. Misrepresentation (6%)
8. Billing/Reimbursement Issue (5%)
9. Access to Care (5%)
10. Provider Attitude and Service (3%)

Top five results of the complaint review

1. Health Plan Position Substantiated (35% of complaints)
2. Compromise Settlement/Resolution (27%)
3. Advised Complainant (17%)
4. No Jurisdiction (8%)
5. Health Plan Position Overturned (6%)