State agency ยท California Department of Managed Health Care
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
Know before you go
The page says you must first file a grievance with your health plan and take part in its process for 30 days; you can go straight to the department if there is a serious threat to your life or the plan denied the treatment as experimental or investigational. The department's form says the request must be made within 6 months of the plan's written appeal response. Send everything at once, because the department does not review documents sent after a complete form is submitted. It regulates plans it licenses, not Medicare or self-funded employer plans.
- Cost
- Free to the patient, according to the department's Independent Medical Review pages and report.
- Where
- California
- How to start
- File a grievance with your plan, wait for its answer or 30 days, then fill in the one Independent Medical Review and Complaint form online, by mail or by fax. The page says the department decides which track fits your case.
- Phone
- 1-888-466-2219, as printed on the provider's page
- Have ready
- Your plan's written grievance response; Your denial letters; Your doctor's records and letters; A printed copy of the form before you submit it online
Where this comes from
- Provider
- California Department of Managed Health Care
- Source we read
- https://www.dmhc.ca.gov/FileaComplaint.aspx
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy
- Program or service
Coverage Rights state-by-state appeal steps
A nonprofit website that gives each state's steps for appeal, external review and complaint when an insurer denies or delays a treatment, with a focus on medicines. No helpline or letters.
From Aimed Alliance