Common Problems

Click on the problem below for more information.

I cannot get the referral that I want.
I cannot get the treatment (or medicine) that I want.
I have to wait too long for an appointment.
I am being sent home (discharged) from the hospital too soon.
I got a bill for care that I received.
I got a bill for emergency care that I received.
I think I received poor care.
I was treated rudely.
My doctor (or hospital) is no longer with my health plan.
I lost my job and I am worried about losing my health insurance.
My insurance is being cancelled.

I cannot get the referral that I want.

You can file a complaint with your plan. If your health problem is urgent, meaning it is a serious threat to your health, you can ask the health plan for an expedited review. Your plan must give you a decision in 3 days. If you still cannot get an appointment, call the HMO Help Center.

I cannot get the treatment (or medicine) that I want.

Ask your doctor or your health plan to put the reason you cannot get the treatment in writing. If you disagree, you can file a complaint with your plan. If your health problem is urgent, meaning it is a serious threat to your health, ask the health plan for an expedited review. Your plan must give you a decision in 3 days. If you disagree with your plan's decision, contact the HMO Help Center.

I have to wait too long for an appointment.

I am being sent home (discharged) from the hospital too soon.

Call your health plan and ask for an expedited review. You can stay in the hospital until your review is completed. However, you may have to pay the bill if the review is in the plan's favor. Your plan must give you a decision within 3 days, or sooner if needed. You should also call the HMO Help Center and say your problem is urgent. If you are in a Medicare Advantage plan, call Lumetra at 1-800-841-1602. If you are in a Medi-Cal managed care plan, call the Medi-Cal Ombudsman at 1-888-452-8609.

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I got a bill for care that I received.

Usually, a doctor, hospital, or other provider in your health plan's network can bill you only for your deductible, co-pay, or co-insurance. If you get a bill for another cost, call the billing office that sent you the bill and ask them to explain the bill to you. If you disagree, file a complaint with your plan. If you are not satisfied with your plan's decision, contact the HMO Help Center.

I got a bill for emergency care that I received.

Your health plan must cover emergency care wherever you receive it. If your plan does not pay the bill, file a complaint with your health plan. If you are not satisfied with your plan's decision, contact the HMO Help Center.

I think I received poor care.

Call your health plan and explain the problem. You can file a complaint with your health plan. If you are not satisfied with your plan's decision, you can contact the HMO Help Center. You can also complain to the licensing agency that oversees the provider who gave you the care.

I was treated rudely.

If a staff person at a medical office treats you rudely, you should tell your doctor, the nurse, or the office manager. If you are treated rudely by your doctor, you may want to change doctors. You can also call your health plan and explain what happened. Your health plan will help you find another doctor if you want.

My doctor (or hospital) is no longer with my health plan.

You will need to change to a new doctor (or hospital) that is in your health plan. Contact your health plan for a list of doctors or hospitals. You should ask your old doctor to send your medical records to your new doctor. In some cases, you can continue with your same doctor or hospital for some time.

I lost my job and I am worried about losing my health insurance.

Try to keep your health insurance until you get a new health plan through a new job. Enroll in Federal COBRA/Cal-COBRA or individual insurance as soon as you can. You usually have to enroll within 60 days of being notified of your Federal Cobra/CAL-COBRA rights.

My insurance is being cancelled.

Your health plan may cancel your insurance if you or your employer did not pay your premiums. If this happens, call your plan right away and try to arrange payment. If the employer did not pay, read about HIPAA and Conversion Plans.
A health plan can also cancel insurance if the member used fraud and deception to get services or violated the contract in other ways.
Your insurance may also end because your employer stops offering health insurance to employees. For information on continuing your coverage if your employer stops offering insurance, read about HIPAA and Conversion Plans.
If you think your insurance was cancelled because of your health condition or because you need medical care, contact the HMO Help Center.

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