What is a Medi-Cal consumer complaint?

Any California managed care plan participant (whether on a private plan or Medi-Cal plan) may submit a consumer complaint to the Department of Managed Health Care (DMHC) for a consumer complaint, aside from certain excluded county-run health systems. These requests may only be submitted after you have filed a grievance with your managed care plan and disagree with the outcome. You have 180 days (six months) from the date of the adverse grievance decision to file a complaint.

According to DHMC’s complaint website, a consumer complaint addresses issues such as “billing problems, cancellation of coverage, claim and copay disputes, delays in getting an appointment, referral or authorization, access to translation services, finding an in-network doctor, hospital, or specialist, [and] complaints about a doctor or plan and continuity of care.”

Other issues may be covered by an independent medical review. For more information, see our article about Medi-Cal appeals.