Medi-Cal Managed Care Complaints

All Medi-Cal Managed Care plans have a customer/member service office you can call for help. Look on your membership card for the number of your plan.

Topics on this page

• Talk to your doctor or plan
• File a complaint with your plan
• File a complaint with the state
• More information and help with Medi-Cal

Talk to your doctor or plan

Try to talk to your doctor or health plan about your problem. If that doesn’t work, you can file a complaint.

File a complaint with your plan

• Call your plan and file a complaint over the phone or in writing. A complaint is also called an appeal or a grievance.
• Your plan must give you a decision within 30 days, or in three days if your problem is urgent.
• If you are not satisfied with your plan ’s decision, or the plan does not meet the deadline for giving you a decision, file a complaint with the state.

File a complaint with the state

Your plan must do what is decided in the complaint. You have two ways to complain:

• Ask for a Medi-Cal State Hearing at 1-800-952-5253. This is a review of your problem by the state. If Medi-Cal stops a service you are getting and you ask for a hearing, Medi-Cal will continue to pay for the service while the hearing is being conducted.

or

• Call the HMO Help Center at 1-888-466-2219.

Please note: If you file an appeal with the HMO Help Center and are not satisfied, you can still ask for a State Hearing. However, if you get the State Hearing first, you cannot file an appeal with the HMO Help Center.

More information and help with Medi-Cal

• A Medi-Cal guidebook for people with disabilities and seniors. This guidebook explains the two kinds of Med-Cal and how to choose the right one.
• Check out the Medi-Cal website.
• For help with your problem, complaint or Fair Hearing, call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609 (toll-free). The office is open 8am–5pm, Monday to Friday. Help is provided in many languages.

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