SJMS 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 Care (DMHC)
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.
California Department 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 CDI also provides a simple complaint form, which is available at www.insurance.ca.gov.
Medicare: 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 www.cahealthadvocates.org.
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.