California Department of Managed Health Care
The Department of Managed Health Care (DMHC) regulates all HMOs and Anthem Blue Cross and Blue Shield PPOs. When consumers experience problems with their health plan they can contact the department for assistance. The department ensures that health plans follow the law and that health plan members receive the right care at the right time.
The Help Center is a free consumer assistance service for those instances when a consumer has been denied health care or is dissatisfied with his/her health plan’s decision. Issues the Help Center addresses could involve the following:
- Difficulty in obtaining a diagnosis or evaluation;
- Difficulty in obtaining a comprehensive treatment plan;
- Difficulty in obtaining referrals to specialists and authorizations for treatment;
- Denial, delay, or modification of appropriate interventions and treatment programs, including speech, occupational, and physical therapies;
- Denial of appropriate medications;
- Denial of investigational therapies; and
- Difficulty in obtaining supplies or other medically necessary services and treatments.
DMHC will work with consumers and their health plan to resolve these disputes.
If treatment has been delayed, denied, or modified, consumers have the right to an independent medical review. The decision by an external medical expert, who has no financial interest, is binding on the plan.
For health care help and information, contact the Help Center at 888/466-2219 or visit www.healthhelp.ca.gov.