Rate of Inquiries and Complaints About HMOs Received by DMHC

Any HMO member, by law, can contact DMHC if they are not satisfied with decisions made by their HMO about their medical care or insurance. The rate at which HMO members contact DMHC with inquiries and complaints is one measure of how well HMOs meet their members’ needs and solve problems when they happen.

This chart shows the plans’ overall effectiveness in communicating with members. It reports inquiries, formal complaints and requests for IMRs filed with DMHC’s Help Center. Members’ inquiries include questions about a health plan’s grievance and appeals process, coverage, claims or billing, enrollment, or customer service issues.

What do the stars mean?

The score is shown as the rate by which HMO members make inquiries, file complaints, or file IMRs with the Department of Managed Health Care (DMHC). Longer bars mean that a greater percentage of that HMO’s members contacted DMHC to make inquiries about their health plan.

What Is the Source?

This data came from the DMHC’s 2013 Independent Medical Review and Complaint Results report. For further information about the data on this page, please go to About the HMO Independent Medical Review and Complaint Ratings.

This table shows the rate of inquiries, filing complaints, or filing IMRs with the DMHC in 2013 regarding California’s largest HMOs.

Per 10,000 HMO Members
  • 0 (Better)
  • (Worse) 50
Aetna Health of California, Inc. - HMO 13.0 Horizontal bar, 26 units
Anthem Blue Cross - HMO * 22.0 Horizontal bar, 44 units
Blue Shield of California - HMO * 17.0 Horizontal bar, 34 units
CIGNA - HMO 31.0 Horizontal bar, 62 units
Health Net of California, Inc. - HMO 17.0 Horizontal bar, 34 units
Kaiser Permanente (Northern and Southern California) 10.0 Horizontal bar, 20 units
UnitedHealthcare of California - HMO 22.0 Horizontal bar, 44 units
Western Health Advantage - HMO 15.0 Horizontal bar, 30 units
Sharp Health Plan - HMO 8.0 Horizontal bar, 16 units
*Rates for Anthem Blue Cross and Blue Shield include aggregated data for both their HMO and PPO health plan products that are regulated by the Department of Managed Health Care.

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