Independent Assistance For Health Care Consumers
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HEALTH RIGHTS HOTLINE Independent Assistance For Health Care Consumers |
If you have a problem with your health plan, the rights you have depend on the type of plan you are in and who pays for your coverage. The Health Rights Hotline encourages you to try to resolve your problem first with your doctor, medical group, or health plan. If you still have questions, the Health Rights Hotline can help you understand your rights. There are also private groups, and state and federal agencies, that you should know about. The organizations listed below may be able to help.
While most of these organizations have standard time frames for helping consumers or investigating complaints, some will take faster action if the situation is urgent. If your problem is life threatening or may cause permanent harm to your health, ask for "expedited" or "emergency" assistance.
If you are in any kind of health maintenance organization or HMO, whether through your job, through Medicare or Medi-Cal, or if you have coverage through Blue Cross or Blue Shield, you can contact the California Department of Managed Health Care (DMHC). The DMHC oversees health plans. However, unless your problem is an emergency, the DMHC requires that you work with your health plan to resolve your problem for at least 30 days before the DMHC will take your complaint.
California Department of Manged Health Care (DMHC)
HMO Helpline
(888) 466-2219 (toll free)
If you are in a preferred provider organization or PPO, or most other types of plans, the California Department of Insurance regulates these programs.
California Department of Insurance (DOI)If you are on Medicare, you may contact the Health Insurance Counseling and Advocacy Program (HICAP). HICAP provides objective information regarding consumers' rights in Medicare. Other resources for Medicare beneficiaries include:
(800) 927-4357 (toll free)
Health Insurance Counseling and Advocacy Program (HICAP)
(800) 434-0222 (toll free)Centers for Medicare & Medicaid Services (CMS)
(415) 744-3617California Medical Review, Inc. (CMRI)
If you are enrolled in a Medi-Cal HMO, your additional resources include:
- Health Care Options if you have a problem with joining or leaving a health or dental plan.
- The California Department of Health Services Medi-Cal Managed Care Ombudsman to help you resolve a problem with your health plan.
- Your eligibility worker, whose name and telephone number appear on notices you get from the county, if you are having a problem with your Medi-Cal eligibility.
Action Tip You also have the right to request a state hearing to have an independent judge decide what is right in your case.
Health Care Options Helpline
(800) 430-4263 (toll free)California Department of Health Services
Medi-Cal Managed Care Ombudsman
(888) 452-8609 (toll free)California Dept. of Social Services
State Hearings
(800) 952-5253 (toll free)
Refer to the fact sheet on "Appeal Rights in Medi-Cal Health and Dental Plans" for more information.
If you have private coverage through your employer or union, your benefits may be managed or "administered" by another company whose name might sound like an insurance company. Employer sponsored plans are also called "ERISA" plans, meaning they are governed by the federal Employee Retirement Income Security Act. Your rights to appeal may be different. Ask your benefits administrator or union representative for assistance and an explanation of the rules that apply. You also may contact the federal Department of Labor (DOL), which regulates employer-sponsored plans. In general, DOL does not provide any assistance to individuals. However, DOL will track your complaint to see if there is a pattern of problems with a particular employer-sponsored plan.
U.S. Department of Labor (DOL)
(415) 975-4600
Health care coverage can be complicated, but you do have rights. The HEALTH RIGHTS HOTLINE can assist you personally if you live in one of the following California counties: El Dorado, Placer, Sacramento, or Yolo. The HEALTH RIGHTS HOTLINE is a totally independent, free service which provides information and assistance about your rights as a health care consumer. Trained counselors will answer your questions and help you resolve issues with your medical group or health plan. If you need assistance, give us a call.
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