You have called eleven names on the plan's list. Four numbers are dead, five are not taking new patients, one has a wait until February and one is a chiropractor. The plan's member services line has told you, kindly, to keep trying. There is a body whose entire job is to make that stop, it costs nothing, and most people never call it.
The short answer: the Department of Managed Health Care Help Center — 1-888-466-2219, healthhelp.ca.gov — is the free regulator that makes health plans answer. California law gives you a non-urgent appointment with a non-physician mental health provider within ten business days of the request, follow-up appointments within ten business days of the prior one while you are in a course of treatment, and out-of-network care at in-network cost when the network cannot deliver. Filing costs nothing, touches nothing about your coverage or your record, and most access cases end with the plan finding an appointment it could not find the week before.¹ ²
This is the enforcement arm of the 10-day rule. If your problem is a denied or cut-off service rather than access, the neighbouring worksheet is the one you want. Appeal a denial →
Before you start: what the law actually promises
Copy the row that matches your situation into the complaint. Vagueness is what kills these; a statutory standard and two dates is what moves them.
| Your situation | The standard¹ |
|---|---|
| First appointment with a therapist, counsellor or other non-physician mental health or substance use provider, non-urgent | Within 10 business days of the request |
| Follow-up appointment while you are in a course of treatment for an ongoing mental health or substance use condition | Within 10 business days of the prior appointment — and the statute says this does not limit coverage to once every ten business days |
| Urgent appointment that does not need prior authorization | Within 48 hours of the request |
| Urgent appointment that needs prior authorization | Within 96 hours of the request |
| Non-urgent appointment with a physician specialist, including a psychiatrist | Within 15 business days of the request |
| Non-urgent primary care | Within 10 business days of the request |
| Nothing available in-network, and the care is medically necessary | The plan "shall arrange for the provision of covered services from providers outside the plan's network," with your cost-sharing at the in-network level¹ |
The last row is the one plans most often decline to acknowledge, and it is the one that gets people seen.
My situation: · The standard that applies:
Confirm who regulates your plan
One sentence to member services:
Is this plan regulated by the Department of Managed Health Care?
Most Californians are covered by it: HMOs, Kaiser, most Blue Shield plans, most Medi-Cal managed care, and many PPOs. If the answer is no, your regulator is the California Department of Insurance, at 1-800-927-4357 — the same procedure with a different number. If you are told the plan is self-funded by your employer, neither state regulator has jurisdiction over the benefit design, and the route is the federal one in the appeal worksheet.
Plan: · Member ID: Regulator: ☐ DMHC ☐ CDI ☐ self-funded — told by on / /
Build the timeline before you build the argument
The case turns on dates. Write them down now, from your own notes and call history, and stop trying to remember them.
| Date | What happened | Who I spoke to | Reference |
|---|---|---|---|
| I first requested an appointment | |||
| The plan offered / said | |||
| I called back | |||
Then count. More than ten business days between your request and the first available non-urgent appointment with a non-physician mental health provider is the violation.¹ Business days, so weekends and holidays are out. Write the count here: business days.
If your complaint is about an in-network list that does not work, keep the evidence of that too: the names you called, the date, and what each one said. A list where seven of eleven numbers are unreachable or closed to new patients is its own finding, and it is the kind of pattern the department looks for.
Names called: · Unreachable or not accepting: · Soonest appointment offered anywhere: / /
Give the plan its one required chance
For most complaints the department will ask whether you filed a grievance with the plan first and gave it thirty days. So file one, properly, and note the number.
I am filing a formal grievance about timely access to mental health care. I requested an appointment on [date] and the earliest offered is [date], which is more than ten business days. I am also requesting that the plan arrange out-of-network care at in-network cost-sharing if the network cannot meet the standard. Please confirm the grievance number in writing.
Grievance # · Filed / / · Thirty days ends / /
Two exceptions skip the wait entirely. Cases involving an imminent and serious threat to health, and cases where the plan simply is not responding. If either fits, say so at Step 4 and do not wait out the month.
☐ Urgent — the threat, in one sentence: ☐ The plan has not responded at all since / /
File — fifteen minutes, by phone or on the web
Call 1-888-466-2219 or file at healthhelp.ca.gov. Say the category plainly, then read your timeline.
I am filing a complaint about timely access to mental health care. My plan has not offered an appointment within ten business days, I filed a grievance on [date], and I have the dates documented. I am also asking the plan to arrange out-of-network care at in-network cost, which nobody has offered.
Have ready: your member ID, the grievance number, the timeline from Step 2, the list of providers you called, and any written denial. If you want to send documents, ask at the start of the call where to send them and get the case number first.
Case # · Filed / / · ☐ standard ☐ urgent Documents sent / / · To:
Answer quickly, and keep the number where you can see it
The Help Center may follow up for documents; answer the same week. The plan is required to respond to the regulator, which is exactly why this works when your own eleven phone calls did not.
If the case turns out to be about a denied or cut-off service rather than access, the department may route you to Independent Medical Review instead — free, and covered step by step in the appeal worksheet.
Follow-up received / / · Responded / / · Outcome:
While the case runs
- Keep looking, and keep the log. If you find care yourself in the meantime, the complaint is still worth finishing; a resolved access problem does not un-violate the standard, and the record matters for the next person.
- If you paid out of pocket because nothing in-network was available, say so and ask for reimbursement as part of the resolution.
- If the wait is long and the situation is deteriorating, that changes the category. Call back and say the word urgent, with the specific reason.
- If money is the immediate obstacle rather than the network, there are routes that do not run through the plan at all. What a sliding scale actually is → · County behavioural health, and what changed under Prop 1 →
What happens next
Urgent access cases move in days; standard complaints commonly resolve inside about thirty days. Most end with an appointment materialising, or with the plan arranging out-of-network care at in-network cost — which is what the statute required in the first place.¹ Your complaint also becomes data. The department finds plans with systemic timely-access problems by looking at the pattern of files like yours, so the afternoon you spent counting business days is also the reason somebody else's list gets audited.
Q&A
Q: How do I file a complaint against my health plan in California? A: Call the DMHC Help Center at 1-888-466-2219 or file at healthhelp.ca.gov. It is free and no lawyer is involved. File a grievance with the plan first and give it thirty days, unless the case is urgent or the plan is not responding at all. Access complaints commonly resolve with the plan producing an appointment or arranging out-of-network care at in-network cost.² ¹
Q: How long is my plan allowed to make me wait for a therapist? A: Ten business days from the request for a non-urgent appointment with a non-physician mental health or substance use disorder provider, and ten business days from the prior appointment for follow-ups while you are in a course of treatment.¹
Q: What if there is genuinely nobody in-network? A: Then the plan is required to arrange covered services from providers outside its network where medically necessary, and your cost-sharing stays at the in-network level.¹ Ask for that specifically, in writing, and name it in the complaint if you are refused.
Q: Will filing hurt my coverage, or go on some record? A: Grievances and regulator complaints are a routine, regulated part of how plans operate. Filing one uses the plan; it does not put you at odds with it.
Q: My plan is not regulated by the DMHC. A: The California Department of Insurance handles the rest, at 1-800-927-4357, with an equivalent process. A self-funded employer plan is federal ground; see the appeal worksheet's ERISA section.
Q: Can I file for my child, or for a parent? A: Yes, as the enrollee's parent, guardian or authorised representative. Expect to confirm your authority once, at the start.
Our therapist directory: See its current status →
Sources
- California Health and Safety Code §1367.03 — appointment waiting-time standards: urgent appointments not requiring prior authorization "within 48 hours of the request for appointment" and those requiring it "within 96 hours"; non-urgent primary care "within 10 business days of the request for appointment"; non-urgent specialist physician appointments "within 15 business days"; non-urgent appointments with a "nonphysician mental health or substance use disorder provider: within 10 business days of the request for appointment"; non-urgent follow-up appointments with a non-physician mental health or substance use disorder provider "within 10 business days of the prior appointment," which "does not limit coverage for nonurgent followup appointments ... to once every 10 business days"; and the requirement that a plan "shall arrange for the provision of covered services from providers outside the plan's network if unavailable within the network if medically necessary for the enrollee's condition," at in-network cost-sharing. The follow-up standard was added by SB 221 (2021, Wiener) — california.public.law.
- California Department of Managed Health Care, Help Center — file a complaint online or by phone at 1-888-466-2219 — dmhc.ca.gov · healthhelp.ca.gov.
- Cal. Code Regs. tit. 28, §1300.68 — a plan's grievance system must receive, review and resolve grievances within 30 calendar days of receipt — law.cornell.edu.
- California Department of Insurance, consumer hotline 1-800-927-4357 — insurance.ca.gov.
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