Q: How do I file a complaint against my health plan?
A: Two steps. Step 1: file a grievance with your plan — phone or member portal; the word "grievance" triggers a formal process with a 30-day response deadline. Step 2: if unresolved after 30 days (or immediately for urgent issues), contact the DMHC Help Center: 1-888-466-2219 or healthhelp.ca.gov. It's free, no lawyer needed, and the DMHC can order the plan to act, including through Independent Medical Review for denials of care.
Worked example: no therapy appointment offered for 6 weeks → grievance filed June 1 → no fix by July 1 → DMHC case opened → plan produces an appointment. Access complaints are among the most commonly resolved.
Do this: keep a dated log of every call — names, dates, what was offered. The log is the complaint.
If the denial was about medical necessity, there is a stronger route than a complaint. An Independent Medical Review puts your file in front of doctors outside your plan, costs you nothing, and is binding on the plan — and in mental health cases the state's own published determinations for 2023–2025 ran about 77% against the plan. The IMR route, with every deadline →
Sources
- Department of Managed Health Care Help Center — complaint routes, the toll-free line 1-888-466-2219 and the TDD line 1-877-688-9891 — dmhc.ca.gov.
- Health & Safety Code §1368.02(b) — the notice every plan must print in 12-point boldface telling you when you may bring the department in, including a grievance unresolved for more than 30 days — leginfo.legislature.ca.gov.
Checked 17 August 2026.