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Independent Medical Review and Complaint Reports
The DMHC helps members who are having a problem getting the healthcare service(s) they need. The DMHC has provided a searchable database of IMR and arbitration decisions, as well as reports on complaints made against health plans. Search our databases below to find more information about IMRs and complaints.
IMR and Complaint Reports
Reporting to the public is an important part of the consumer protections provided by the DMHC. Below is information related to consumer complaints, IMR and arbitration decisions
Independent Medical Review Decisions
The IMR program was created by the California Legislature and provides a vital service for California health plan members. In our database, you’ll find all IMR decisions since the program began on January 1, 2001.
Complaint and Independent Medical Review Reports
The DMHC publishes an annual report that details the number and types of complaints or grievances received during the calendar year, including IMR data.
Arbitration Decisions
When a health plan uses arbitration to settle disputes with its enrollees, the health plan is required to file a copy of the written arbitration decision to the DMHC within 30 days of the decision. The filed copy must include the amount of the award, the reasons for the award and the names of the arbitrators. By law, the names of the plan, enrollee, witnesses, attorneys, provider, plan employees and plan facilities are deleted from the copy filed with the DMHC. These redacted copies of the decisions are filed each quarter and every effort will be made to post them on this site within the following quarter to be available to the public.