Health Care

Whether attending to routine yearly checkups or facing a serious health crisis, consumers may encounter problems with healthcare insurance as well as providers of healthcare. Below, you will find information to assist you in dealing with such problems and on how to report various types of healthcare-related complaints.

Healthcare Insurance

Affordable Care Act

California’s health insurance program under the Affordable Care Act is called Covered California.

You may apply online at the Covered California website.

To apply in person, Covered California’s Get Help page has a list of free counselors in your area.

Health Maintenance Organization (HMO) Plans

To report problems with a Health Maintenance Organization (HMO), including issues about medical care, prescriptions, preventive testing, and mental health services, contact the Department of Managed Health Care online or by calling their consumer help line: (888) HMO-2219 or (877) 688-9891 (TTY).

If your complaint or dispute involves a serious or imminent threat to your health, such as the denial of treatment, inform the Department of Managed Health Care that you are contacting them about an urgent matter.

Traditional Fee-For-Service Plans

To report problems with indemnity policies or traditional fee-for-service plans (such as Blue Cross/Blue Shield), contact the California Department of Insurance online or by calling their consumer help line: (800) 927-4357 or (800) 482-4833 (TTY).

Preferred Provider Organizations

To report problems with a Preferred Provider Organization (PPO), including issues of medical care, prescriptions, preventive testing, and mental health services:

• For most PPOs, including where the underwriting company is a licensed insurance company, contact the California Department of Insurance online or by calling their consumer help line: (800) 927-4357 or (800) 482-4833 (TTY).
• If you have a complaint about the California Blue Shield PPO, Anthem Blue Cross PPO, Delta Dental PPO, or VSP PPO, contact the California Department of Managed Health Care online or by calling their consumer help line: (888) HMO-2219 or (877) 688-9891 (TTY).

Self-Insured Health Plans

To report problems with a self-insured health plan:

• For most self-insured health plans that fall under the Employee Retirement Income Security Act (ERISA), contact the United States Department of Labor, Employee Benefits Security Administration.
• For self-insured health plans that are sponsored through school districts, other municipalities, and churches, file a complaint with the plan directly.

Multiple Employer Welfare Arrangements

Multiple Employer Welfare Arrangements (MEWAs) permit employer members of trade, industry, professional, and other associations to create trust funds for the purpose of offering health care benefits to employees. Only MEWAs issued a certificate of compliance by November 30, 1995, from the California Department of Insurance are allowed to operate in the state.

Report complaints about MEWAs to the California Department of Insurance online or by calling their consumer help line: (800) 927-4357 or (800) 482-4833 (TTY).

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Doctors and Dentists

Dentists

To report problems with dentists, registered dental assistants, and registered dental hygienists, contact the Board of Dental Examiners.

Doctors

To report problems with medical doctors, registered dispensing opticians, spectacle lens dispensers, contact lens dispensers, licensed midwives, and research psychoanalysts, contact the California Medical Board online or by phone at (800) 633-2322 (toll-free).

If your doctor is an osteopathic doctor, contact the Osteopathic Medical Board of California online or by calling them at (916) 928-8390.

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