Grievance & Appeals

Visit our Health Plans page, select the Health Plan that is on your insurance card, and click "Grievances & Appeals" to submit a Grievance:

Health Plans page

***IMPORTANT***

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance with your health plan, first call your health plan at (800) 584-0724 and use their grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance regarding an emergency, a grievance that has not been satisfactorily resolved by your health plan or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance.

You may also be eligible for an Independent Medical Review (IMR). If you are eligible for an IMR, the process will include an unbiased review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department's web site http://www.hmohelp.ca.gov/ has complaint forms, IMR application forms and instructions.