MMCMS is an advocacy organization supporting physicians and their patients.
We are unable, however, to resolve specific patient inquiries such as bills
or claims, medical necessity or similar complaints patients may have regarding
insurance companies, health plans or physician offices. There are many excellent
resources devoted to helping patients with these concerns. Below are some
resources that may be of assistance:
California Department of Managed Health
The HMO Help Center is a part of the DMHC. The DMHC oversees
HMOs and some other health plans in California. The HMO Help Center can
help you with your complaint and can also provide you with an Independent
Medical Review (IMR), if you qualify. Call 888-HMO-2219; the TDD line is
877-688-9891. The HMO Help Center is open 24 hours a day, 7 days a week
and can provide help in many languages.
of Insurance (CDI)
The CDI regulates point-of-service and certain
Preferred Provider Organization (PPO) health plans. The CDI toll-free number,
dedicated to the handling of complaints and inquiries is 800-927-HELP for
all areas of California except area codes 213, 310, and 818, for which you
should dial 213-897-8921; the TDD line is 800-482-4833. The The CDI also
provides a simple complaint form,
How to Get Help
Free individual counseling about Medicare and other
health care issues is available through the Health Insurance Counseling
and Advocacy Program (HICAP). HICAP counseling is available in every county
in California. For counseling or more information call 800-434-0222 or visit
MEDI-CAL Managed Care Office of the Ombudsman
The Medi-Cal Managed
Care Office of the Ombudsman helps solve problems from a neutral standpoint
to ensure that Medi-Cal patients receive medically necessary covered services
for which plans are contractually responsible. The Ombudsman considers all
sides in an impartial and objective way and develops fair solutions to health
care access problems. Contact 888-452-8609.
MedlinePlus will direct you to information to help answer health questions.
MedlinePlus brings together authoritative information from NLM, the National
Institutes of Health (NIH), and other government agencies and health-related
organizations. Preformulated MEDLINE searches are included in MedlinePlus
and give easy access to medical journal articles. MedlinePlus also has extensive
information about drugs, an illustrated medical encyclopedia, interactive
patient tutorials, and latest health news.