There are several things you can do if you have a problem with your health plan. First, contact your health plan to file a complaint. (A complaint is also called a grievance or an appeal.) You can file a complaint with your health plan over the phone or in writing. You may also be able to file a complaint on your health plan's website.
If your health problem is urgent, or if you already filed a complaint and are not satisfied with your health plan's decision, contact the Help Center at the Department of Managed Health Care (DMHC). An urgent problem is a serious threat to your health. You can also file a complaint with the Help Center if your HMO does not make a decision within 30 days.
The Help Center can help you with your complaint. We will also provide you with an Independent Medical Review (IMR), if you qualify.
- If you are told that you cannot get the care you need, ask for the reason in writing.
- Talk to your doctor about your problem.
- When you make a phone call, take notes. Write down the date of your call, the name of the person you talk to, and what the person says.
- Have someone with you for extra support.
- Act soon. If you wait longer than 6 months, you may lose the right to file a complaint, ask for an IMR, or take other action against your health plan.
- Read about some Common Consumer Q&A people have with their health plans.