Submit an IMR/Complaint Form
Are you an enrollee with a complaint about your health plan? Has a service/treatment you or your doctor requested been denied, modified or delayed? The Help Center can help. Fill out and submit an Independent Medical Review/Complaint Form or call our Help Center at 1-888-466-2219 for assistance. Once your Independent Medical Review/Complaint Form has been received, the Help Center will determine whether your complaint qualifies for an Independent Medical Review (IMR) or if it will be reviewed as a Consumer Complaint...
General Information: 888-466-2219
Frequently Asked Questions
The Consumer Complaint process assists consumers in resolving issues with their health plans, including the following types of complaints:
- Improper denial or delay in settlement of a claim.
- Health claims that have been denied by the health plan because the service or treatment is not covered under the contract.
- Legal interpretations of policy language, provisions, and terms.
- Bad faith allegations and other demands for extra payments under the health insurance contract.
- Alleged illegal cancellation or termination of a policy.
- Alleged misrepresentation by an agent, broker, or solicitor.
- Alleged theft of premiums paid to an agent, broker, or solicitor.
- Issues with providers, medical groups and pharmacies.
If your health plan denies your request for medical services or treatment, you can file a complaint (grievance/appeal) with your plan. If you disagree with your plan's decision, or it has been at least 30 days since you filed a complaint with your health plan you can request an IMR with the DMHC. The DMHC staff will determine whether your issue qualifies for an IMR.