Health plan information, help with complaints, grievances, health coverage, health insurance, denials, independent medical review, external review

Independent Medical Review & Complaint Process. If your Health Plan denies, changes or delays your request for medical services, denies payment for emergency treatment or refuses to cover experimental or investigational treatment for a serious medical condition, you can apply for an Independent Medical Review (IMR).

Use the health plan dashboard to view or compare health plan information. The health plan dashboard features health plan contact information, enrollment data, complaint and IMR data, enforcement actions, and financial data.

Department of Health Care Services. Governor's Budget Proposal 2025-26. The proposed 2025-26 Governor's Budget for DHCS allocates $193.4 billion in total funds, including $42.8 billion from the General Fund, and supports 4,821.5 positions.

2024年11月26日 · Services Submit an IMR/Complaint Form. If your health plan denies, changes or delays your request for medical services, denies payment for emergency treatment or refuses to cover experimental or investigational treatment for a serious medical condition, you can apply for an Independent Medical Review (IMR).

The Department of Managed Health Care (DMHC) is a regulatory body governing managed health care plans, including Health Maintenance Organizations (HMOs) and most Medi-Cal managed care plans in California.The DMHC was created as the first state department in the country solely dedicated to regulating managed health care plans and assisting consumers to …

2025年3月14日 · Medical Audits and Corrective Action Plans. The Department of Health Care Services (DHCS) works with the Department of Managed Health Care (DMHC) to conduct routine medical surveys of Medi-Cal Managed Care Health Plans (MCPs) on …

1. You have the right to have your urgent grievance resolved within 72 hours. You have the right to immediately contact the Department of Managed Health Care (DMHC) regarding your urgent grievance at 1-888-466-2219, or TDD line 1-877-688-9891, or at their internet web site: www.dmhc.ca.gov.

DMHC Help Center. The DMHC Help Center (HC) educates consumers about their health care rights, resolves consumer complaints against health plans, helps consumers understand their coverage and assists consumers in getting timely access to appropriate health care services.

Explainer: Network Adequacy and Health Care Access Regulations Current as of January 2024 3 CHBRP.org insurance subject to regulation and/or administration by DHCS, DMHC and/or CDI.5 Although many of the requirements are similar, there are some differences between requirements for plans and policies based on the regulator.