Managed Care or HMO Problems?

In California, most HMOs and some Preferred Provider Organizations (PPOs) are licensed and regulated by the Department of Managed Health Care - DMHC. The DMHC provides assistance to consumers, resolves complaints, and undertakes independent medical reviews. If your problem is with a Medicare provider, you can contact the Health Insurance Counseling and Advocacy Program (HICAP), which is part of the California Department of Aging, at:  800-434-0222. If you are a A Medi-Cal recipient, contact the Department of Health Services (DHS) at: 888-452-8609. This is the webpage for DMHC:  Consumer Information But if you are in any way confused, call the DMHC Help Center at:   888-466-2219 If your dispute involves a serious or imminent threat to your health (such as denial of treatment for life-threatening cancer), call the Help Center and tell them that your call is an urgent matter. If you are having any type of problem in obtaining medical care, obtaining authorization for care, or in securing payment for care received, you are already in a world of hurt and have no need to try to figure it out on your own.  Call them and speak to a human being. If they can't help, they will get you to someone who can.

Copyright 2005, Paul G. Mattiuzzi, Ph.D.