California Department of Managed Health Care

Usted tiene derechos de atención médica. Tiene derecho a apelar si su plan de atención médica le niega, cambia o retrasa la atención. Haga escuchar su voz. Primero, presente un reclamo, a veces llamado apelación o denuncia, ante su plan de salud. Después, de 30 días, puede ponerse en contacto con el Centro de Ayuda del Department of Managed Health Care (DMHC) si su plan de atención médica rechaza la apelación o si no está satisfecho con la decisión de su plan de atención médica. El DMHC puede ayudarle y es una agencia estatal independiente. Las apelaciones ante el DMHC se resuelven favorablemente en 7 de cada 10 casos. Para obtener más información, visite www.DMHC.ca.gov o llame al Centro de Ayuda al 1-888-466-2219. Gratis y se cuenta con ayuda en espa?ol.

Health plans are required to provide treatment for mental health and substance use disorder conditions. Learn more at https://lnkd.in/g_qJWwbS #DMHC #HealthCare #HealthCareRights #BehavioralHealth

The DMHC Help Center is here to educate health plan members about their health care rights. We help resolve complaints, help people understand their coverage and more. Help is available in all languages for free. For more info, visit www.DMHC.ca.gov or call 1-888-466-2219 #DMHC #DMHCHelpCenter #HealthCareRights #HealthPlan

Sorina had to receive emergency health care services at an out-of-network hospital. Afterward, her health care plan denied coverage of the services, leaving Sorina with a $27,000 hospital bill. Through an appeal to the Department of Managed Health Care (DMHC), Sorina did not have to pay the bill. If your health care plan denies health care coverage, you can file an independent appeal with the DMHC. First, file a complaint, sometimes called an appeal or grievance, with your health care plan. Then, after 30 days, if your health care plan denies your appeal, or you are unhappy with the outcome, you can contact the DMHC’s Help Center at www.DMHC.ca.gov or 1-888-466-2219. The DMHC is an independent state agency not associated with your health care plan. Appeals to the DMHC are successful in 7 out of 10 cases. For more information, go to www.DMHC.ca.gov or call the Help Center at 1-888-466-2219. Free help is available in all languages. #DMHC #DMHCHelpCenter

If you aren’t getting the assistance you need from your health plan, or it’s been more than 30 days after filing a grievance, you can contact the DMHC Help Center for help. Call 1-888-466-2219 or visit www.DMHC.ca.gov. #DMHC #DMHCHelpCenter #HealthHelp #HealthCareRights

AB 3275 changes the timeframes for health plans to reimburse, contest or deny provider claims payments for health care services to 30 calendar days. The bill increases the penalty on health plans for not automatically paying interest owed on a claim. The bill also requires health plans treat member complaints about a delay or denial of claim payment as a grievance. This bill takes effect January 1, 2026. #NewYearNewLaws #KnowYourHealthCareRights

On average, 72% of health plan members who submitted #IMR requests to the DMHC received the service or treatment they requested. To learn more, visit: https://lnkd.in/gsM_Hnjk #DMHC #HealthHelp #HealthCoverage #IndependentMedicalReview

California law protects health plan members from balance billing, also known as surprise bills. Learn more about balance billing at https://lnkd.in/gznHPdZ9 #DMHC #HealthCare #HealthCareRights #BalanceBilling #SurpriseBilling

Many Californians have questions about what their premium actually pays for. The Affordable Care Act requires health plans to spend a certain amount of money from premium payments on medical services and quality improvement efforts. For more info: https://lnkd.in/g5-zaJDf #DMHC #HealthCareRights #PremiumRateReview #AffordableCareAct #HealthPlan

The California Department of Managed Health Care (DMHC) is making this resource guide available for health plan members impacted by the state of emergency caused by #wildfires in Southern California. This guide provides information on health plan requirements to help health plan members, as well as contact information for health plans operating in Los Angeles and Ventura counties. DMHC Wildfire Resource Guide: https://lnkd.in/gCYv6DP4