If you are a California resident and your insurer denies your coverage after the independent medical review process, you can file a complaint with the DMHC.^[13]

Complaint information. You can obtain a copy of the complaint form here. Your complaint should include the following information:

• The name and date of birth of the patient;
• The name, address, telephone number, and email address of the parent or guardian, if filing on behalf of a minor child;
• The name of insurance company;
• The patient’s membership number, medical group name, and name of employer;
• The type of complaint (g., authorization of future services);
• The patient’s medical condition or diagnosis;
• The treatment, services, or medications being requested;
• The name and telephone number of the patient’s primary care provider; and
• Brief description of the problem (g., denied treatment, unpaid claim).^[14]

Supporting documents. You should submit the following supporting documents with your complaint:

• A copy of your insurance card;
• Copies of coverage denials or adverse benefit determinations from your insurer;
• Copies of any determinations made by internal and independent medical reviewers;
• Any materials submitted with prior appeals and complaints;
• Supporting documentation from your health care provider;
• A copy of your insurance policy; and
• All responses from your insurer.^[15]

You can submit the complaint and supporting documents online here, fax them to (916) 255-5241, or mail them to:

Help Center
Department of Managed Health Care
980 9^th Street, Suite 500
Sacramento, CA 95814-2725^[16]