File a Complaint

Adele has dealt with chronic pain for many years. Her doctor thought that a certain prescription drug would help her. “My plan said the drug was not medically necessary. So my doctor helped me file a complaint with the state. My case was reviewed by an independent doctor who said I needed the drug. So my plan had to cover the drug for me.”

More stories.

If talking with your doctor or your health plan doesn’t work, you can file a complaint with the plan. A complaint is also called an appeal, review, or grievance. Use the My Complaint worksheet to keep track of your complaint.

What kind of plan do you have?

Learn about different types of plans

• HMO complaints
• Blue Cross/Blue Shield PPO complaints
• Other PPO complaints
• Medi-Cal Managed Care complaints
• Medicare Advantage complaints

Common complaints

• You can’t get a service, treatment, or medicine you need.
• Your plan denies a service and says it is not medically necessary.
• You have to wait too long for an appointment.
• You received poor care or were treated rudely.
• Your plan does not pay you back for emergency or urgent care that you had to pay for.

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