HMO Complaint and IMR Information
What do the stars mean?
If you are having a problem with your health plan, please call 1.888.466.2219 (Department of Managed Health Care – Help Center).
The Department of Managed Health Care (DMHC) is the lead organization in California overseeing managed care or HMOs.
The DMHC licenses and regulates California health plans under authority granted in The Knox-Keene Health Care Service Plan Act of 1975 and as subsequently amended. The Knox-Keene Health Care Service Plan Act is the set of laws passed by the State Legislature to regulate HMOs within the State.
The DMHC has made consumer protection their top priority. DMHC makes sure that health plans follow California managed care laws and remain financially stable. DMHC works every day to solve health care problems and make sure all Californians get the right care at the right time. DMHC’s many activities include running the HMO Help Center where members can call for help with their HMO problems, lodge a complaint against their HMO or apply for an Independent Medical Review of their plan’s denial of health care services or treatments. The Plan Survey division of the DMHC conducts field surveys of HMOs to assess if policies and procedures are in place to ensure high quality healthcare is provided.
The DMHC oversees HMOs through mechanisms that include requiring regular filings of enrollment and financial information, periodic health plan surveys, establishment and enforcement of regulations based on the Knox-Keene Health Care Service Plan Act. The DMHC offers assistance to HMO members through the HMO Help Center, and reviews HMO decisions that deny healthcare services to members through the Independent Medical Review Board.