Managed Health Care, Department of

Department of Managed Health Care (DMHC)

The California Department of Managed Health Care protects consumers’ health care rights and ensures a stable health care delivery system.

General Information: 888-466-2219
Hearing Impaired: 877-688-9891
Fax: 916-255-5241

Frequently Asked Questions

In approximately 60% of IMR cases, the health plan's denial of service was reversed by the health plan or overturned by the Independent Medical Review Organization and the enrollee received authorization for the requested service or treatment. If the IMR decision is in your favor, the health plan must authorize the service(s) or treatment(s) within five business days. The IMR is free, easy, and fast and in most cases, the IMR is decided within 30 days of IMR qualification and receipt of all required documentation. If you need more local, one-on-one assistance in filling out the IMR form, please contact the DMHC at 1-888-466-2219 or the DMHC's Consumer Assistance Program, Health Consumer Alliance, at 1-888-804-3536.
Usually, a doctor, hospital, or other provider in your health plan's network can bill you only for your deductible, co-pay, or co-insurance. If you get a bill for another cost, call the billing office that sent you the bill and ask them to explain the bill to you. If you disagree, file a complaint with your plan. If you are not satisfied with your plan's decision, contact the Help Center.

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.
An IMR is a review of your case by independent doctors who are not part of your health plan. You have a good chance of receiving the service(s) or treatment(s) you need by requesting an IMR. Approximately 60% of enrollee’s that submit IMR requests to the DMHC receive the service(s) or treatment(s) they requested. If the IMR is decided in your favor, your plan must authorize the service(s) or treatment(s) you requested. IMR’s are free to enrollees.

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.

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