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 9th Street, Suite 500
Sacramento, CA 95814-2725[16]