California Insurance Commissioner
California Department of Insurance (CDI) / Department of Managed Health Care (DMHC)
Contact information
- Agency: California Department of Insurance (CDI) / Department of Managed Health Care (DMHC)
- Title: Insurance Commissioner / DMHC Director
- Phone: (800) 927-4357 (CDI) / (888) 466-2219 (DMHC)
- Address: 300 South Spring Street, Los Angeles, CA 90013 (CDI)
- File a complaint: https://www.insurance.ca.gov/01-consumers/101-help/
- External review: https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx
Balance billing & surprise billing protection
AB 72 (effective July 2017) — consumers in HMO/PPO pay only in-network cost-share for non-emergency out-of-network services at in-network facilities. Supplemented by federal NSA.
External review & appeal help
DMHC regulates HMOs + most PPOs; CDI regulates remaining PPOs. Independent Medical Review (IMR) is free, decisions binding on plan. Most overturns favor consumer.
How DenialHelp fits in
You typically need to file an internal appeal with your insurer before California will accept an external review request. DenialHelp drafts that internal appeal in five minutes from your denial letter — physician-ready, cited to medical evidence, and formatted for clean transmission to your insurer. If the internal appeal still loses, you can then file with the California Department of Insurance (CDI) / Department of Managed Health Care (DMHC) for external review.
Frequently asked questions
How do I file an insurance complaint in California?
File online at https://www.insurance.ca.gov/01-consumers/101-help/ or call (800) 927-4357 (CDI) / (888) 466-2219 (DMHC). Most states will investigate insurance company conduct, send the complaint to the insurer for a written response, and report findings to you.
What is the external review process in California?
DMHC regulates HMOs + most PPOs; CDI regulates remaining PPOs. Independent Medical Review (IMR) is free, decisions binding on plan. Most overturns favor consumer. Submit a request at https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx.
Does California protect against surprise balance billing?
AB 72 (effective July 2017) — consumers in HMO/PPO pay only in-network cost-share for non-emergency out-of-network services at in-network facilities. Supplemented by federal NSA.
What if my appeal is denied by California insurance company?
After internal appeal denial, you can request external review through the state insurance department or its contracted Independent Review Organization (IRO). External review decisions are typically binding on the insurer. You can also file a complaint with the California Department of Insurance (CDI) / Department of Managed Health Care (DMHC) regardless of appeal status.
Appeal your California health insurance denial
Upload your denial letter — DenialHelp drafts a physician-ready appeal in five minutes. $39 first-level appeal, money back if we can't draft a strong appeal.
Get started →Contact: hello@denialhelp.com