How to File Complaints About Health Plans

CSAP and the California Department of Managed Health Care held a webinar on the Provider Helpline for those experiencing pervasive problems with insurers. You may view the presentation materials at the links below. Additionally, DHCS was kind enough to share the contact information of the presenters for those who have follow-up questions or issues.

Provider Complaint Section
Independent Medical Review and Complaint Process

Presenter contact info: 

Mario Turner
Branch Manager
Independent Medical Review and Complaint Branch
Department of Managed Health Care
Phone: (916) 255-2348
Email: Mario.Turner@dmhc.ca.gov

Nicholle Sims
Staff Services Manager
Office of the Provider Complaint Section
Department of Managed Health Care
Phone: (916) 384-0803
Email: Nicholle.Sims@dmhc.ca.gov

On a related note, one of our members (thank you!) made CSAP headquarters aware that last year, San Diego’s Office of the City Attorney filed suit against three health plans alleging they misled consumers by using inaccurate provider directories. You may view an article regarding this here. There are no actions taken on these cases to date; however they have apparently gone to oral argument per Sept 8 court documents. Please see the links below. 

People of the State of California vs. Kaiser Foundation Health Plan IncSeptember 8, Tentative Ruling
People of the State of California vs. Health Net LLC, September 8, Tentative Ruling
People of the State of California vs. Molina Healthcare of California

We have been asked if California’s Attorney General Rob Bonta might also be willing to weigh in on this issue. SYASL will be contacting the AG’s Office to see if something is already in the works. If not, the CSAP Board will consider whether to request such action.

The DMHC has agreed to do a follow up webinar in late October – we will let you all know when this is scheduled! 

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