Where do I get help?
Steps to resolving healthcare delivery problems
- Know and understand your healthcare rights and responsibilities.
- Communicate effectively and make sure that your needs/requests are being understood correctly.
- Know your health plan benefits and limitations (what is covered and what is not covered).
- Ask for a supervisor, customer representative or patient advocate.
- Follow your health plan's grievance policy/procedure (or the grievance policy of your provider or hospital).
- Contact the following services for more help:
For Problems with your HMO/PPO Provider
If your HMO does not provide the healthcare to which you are entitled under your contract, or if you encounter a problem that you are unable to resolve with your HMO, contact the Department of Managed Care - HMO Help Center. The Help Center can assist you with the following health plan concerns: medical care, prescriptions, preventive testing and mental health services. The Help Center is available 7 days a week, 24 hours a day.
Department of Managed Health Care (DMHC)
Voice: 888-HMO-2219
FAX: 916-229-0465
TDD: 877-688-9891
Department of Managed Health Care
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Learn More:
Department of Managed Health Care
If you have a "non-Blue" PPO, EPO, POS, indemnity, or association plan
California Department of Insurance (CDI)
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Consumer Hotline: 800-927-HELP (4357)
TDD: 800-482-4TDD(4833)
8:00 am to 6:00pm Monday-Friday (except State holidays)
Learn More:
California Department of Insurance
For COBRA or ERISA complaints or questions
ERISA
Employee Retirement Income Security Act (ERISA) is a federal law that governs self-insured medical plans. Some employers opt for "self-insured" plans. In a self-insured plan, the employer maintains enough money to cover employee medical charges, and then hires a management company (often an insurance firm) to administer the program. For help, contact:
Department of Labor (DOL)
866-444-3272
TTY: 877-889-5627
Learn More:
US Department of Labor - ERISA Enforcement
COBRA or CAL-COBRA
Federal COBRA is a U.S. law that applies to employers and group health plans that cover 20 or more employees. You can keep your group health insurance when your job ends or your hours are cut. You have to pay the premium but you can keep your insurance for at least 18 months. Cal-COBRA is a California law that is similar to the Federal COBRA. Cal-COBRA applies to employers and group health plans that cover from 2 to 19 employees. It lets you keep your insurance for up to a total of 36 months. For help, contact:
Department of Labor Regional Office - (415) 625-2481
**Refer also to the CA Department of Managed Health Care and the US Department of Labor
Learn More:
California Department of Managed Care/COBRA and Cal-COBRA
OR
Problems with Medi-Cal/Medicaid
Adult and Children:
Department of Health Care Services
Medi-Cal Eligibility Division
Releasing Desk
P.O. Box 997413, MS 4607
Sacramento, CA 95899-7413
Learn More:
Department of Health Care Services
Problems with Medicare
Health Insurance Counseling and Advocacy (HICAP) Program Contact Listing (by County).
Learn More: