Oficina del Defensor del Pueblo
The Ombuds Office is an objective, independent resource that helps people who are experiencing issues with the health and/or dental insurance plan they have through Covered California.
¿Cuándo debo comunicarme con la Defensoría del Pueblo?
Call our service center at (800) 300-1506 before contacting the Ombuds Office. You must complete this step before the Ombuds Office can provide you assistance.
Contact the Ombuds Office if you have a health or dental insurance plan through Covered California and you’re experiencing issues with your enrollment or application, and you’ve already done the following:
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You have already contacted the Covered California service center, and
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You completed their escalation process, or
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You have filed a Covered California complaint and it has been more than 30 days and you have not received an update.
If you haven't already done so, start by calling our service center at (800) 300-1506. Then select option one.
Current enrollees should then choose option two. You will then be routed to the main menu to get help with your issue from a service center representative.
After speaking with one of our service center representatives and being unable to have your problem resolved, you can contact the Ombuds Office for help.
To help us find your case information, you must first complete and submit our Contact Form online.
While filling out the form, have this information on hand:
Case ID number (a 10-digit number associated with your account that starts with a five or one), and
Reference number (provided by the service center when they have assisted with a case).
The Ombuds Office will research the case and help find a resolution or explain why a resolution was not reached.
An authorized Covered California representative of our office will contact you by your preferred method, as listed on your form.
We’ll reach out to you with any follow-up questions and will keep in touch with you along the way. We’ll do our best to help resolve your issue as quickly as possible. The timeframe may be affected by how complex your issue is and how much research your case requires.
Our independent contractor, Health Consumer Alliance (HCA), offers free legal advice and representation, including assistance filing a complaint or grievance and arranging a hearing. The Ombuds Office does not provide legal advice.
Contact your county for a resolution for issues with your Medi-Cal coverage.
Covered California doesn’t have the ability to update the county systems that determine Medi-Cal eligibility. There are usually 45 days between the time your completed application is received to when you receive your Benefits Identification Card (BIC). Due to the high volume of new applications, the process is taking longer than normal.
Recursos útiles
Looking for our service center’s phone number or for assistance with something other than a Covered California issue? These resources can help.
Call the service center during normal business hours at (800) 300-1506 (TTY: [888] 889-4500).
The Covered California Service Center can help with the following:
Comparing health and dental insurance plans available in your area.
Applying for health and dental insurance.
Cómo informar un cambio en tu solicitud.
Getting financial help to lower your monthly premium payment.
Managing your account.
Obtaining your Form 1095-A or filing a dispute form for your Form 1095-A.
Answering questions regarding your health and dental insurance plan.
If you continue to have an issue with your account, a service center representative can escalate your case to a specialized group for assistance.
Local County Medi-Cal Offices
You can contact your local county office for assistance with you Medi-Cal coverage or application. They can assist with updates and determinations for Medi-Cal eligibility.
Enlaces relacionados
Oficinas de Servicios Sociales del Condado
Department of Health Care Services
Contact the California Department of Health Care Services (DHCS) for help with Medi-Cal, the program that offers free or low-cost health coverage for California residents who meet eligibility requirements.
El DHCS puede ayudarte con cualquier asunto relacionado con Medi-Cal, por ejemplo
Inscripción acelerada en el plan, cambios de plan y cancelación de la inscripción en el plan.
Problemas de acceso a la atención.
Pedir una tarjeta de identificación de beneficios (BIC), si la oficina local del condado no puede ayudar.
Actualiza los códigos de condado (cuando los consumidores se mudan a otro condado).
Referencias a agencias apropiadas para preocupaciones fuera de su alcance.
La Oficina del Defensor del Pueblo de DHCS puede ayudarte si estás buscando:
Navega a través del sistema de Atención Administrada de Medi-Cal.
Encuentra información para ayudar a acceder a los servicios de salud mental.
Ayudar a los miembros con problemas urgentes de inscripción.
Connect members with local resources in their county who can help.
Serves as an objective resource to resolve issues between Medi-Cal managed care members and managed care health plans.
Información de contacto
Medi-Cal Helpline: (800) 541-5555.
DHCS Ombudsman Office: (888) 452-8609, or
Email: mmcdombudsmanoffice@dhcs.ca.gov.
Enlaces relacionados
Sitio web del Departamento de Servicios de Atención Médica de California
Oficinas de Servicios Sociales del Condado
La Alianza de Consumidores de Salud (HCA, por sus siglas en inglés) ofrece asesoramiento y representación legal gratuitos, incluida la asistencia para presentar quejas y reclamos y buscar audiencias. La HCA es una red de 10 programas de asistencia al consumidor operados por servicios legales comunitarios.
HCA ofrece asistencia legal gratuita en cualquier idioma a los consumidores que tienen problemas con lo siguiente:
Su cobertura de salud.
Inscribirte en un plan.
Elegibilidad.
Renovar su cobertura.
Procesamiento de pagos.
Discrepancias entre Covered California y Medi-Cal.
Usando su cobertura.
Cómo pagar el seguro o los servicios.
Obtener servicios oportunos de cualquier entidad de atención médica.
Información de contacto
(888) 804-3536
Llama de lunes a viernes, de 9:00 a.m. a 5:00 p.m. Te devolveremos la llamada si dejas un mensaje fuera del horario laboral.
Enlaces relacionados
Visita el Centro de Ayuda del Departamento de Atención Médica Administrada (DMHC) si ya presentaste una queja ante tu compañía de seguros de salud, o si existe una amenaza inminente para tu salud.
Si tienes un problema con tu plan de salud o tienes dificultades para acceder a la atención médica, puedes presentar una queja ante tu compañía de seguro. Si no estás conforme con la resolución de la queja por parte de tu compañía de seguro de salud o si llevas 30 días en su sistema de quejas, comunícate con el Centro de Ayuda del DMHC para obtener ayuda.
Si estás experimentando una amenaza inminente o grave para tu salud, comunícate con el Centro de Ayuda del DMHC de inmediato.
El Centro de Ayuda del DMHC puede ayudar con los siguientes tipos de quejas:
Cancellation of covered services.
Denegaciones o retrasos en la atención o los servicios.
Problemas de facturación.
Calidad del cuidado.
Problemas de acceso, incluyendo no obtener una cita a tiempo.
Problemas con proveedores, grupos médicos y farmacias.
Información de contacto
Centro de ayuda del DMHC: (888) 466-2219.
Enlaces relacionados
Sitio web del Departamento de Atención Médica Administrada de California
Centro de ayuda del DMHC
Formulario de quejas/revisión médica independiente de DMHC
The California Department of Insurance (CDI) is a consumer-protection agency that regulates insurance companies, agents and brokers. CDI ensures that insurance products and services are available to enrollees in a timely manner, and that they deliver fair and equal benefits.
Comunícate con CDI si tienes alguna pregunta o inquietud sobre lo siguiente:
Solicitudes de revisión médica independiente (IMR).
Preocupaciones con coberturas de seguros de salud o compañías.
Licensing and other information for insurance agents and brokers.
Información sobre la cobertura de atención médica para personas mayores.
Verificar el estado de la licencia de una persona o agencia.
Resolving insurance-related enrollee complaints.
Investigar y perseguir el fraude de seguros.
Enlaces relacionados
Sitio web del Departamento de Seguros de California
Recursos para el consumidor de CDI
Centro de información para personas mayores de CDI
Verifica el estado de la licencia para agentes o corredores, u obtén información de la compañía de seguros.
Presenta una queja o completa una solicitud de Revisión Médica Independiente.
The California Department of Corrections and Rehabilitation (CDCR) manages the State of California's prison system with an emphasis on public safety, rehabilitation, community reintegration and restorative justice. It can assist with visitation and facility questions.
Each California county has an Adult Protective Services (APS) agency to help elder adults (60 years and older) and dependent adults (18 to 59 who are disabled), when these adults are unable to meet their own needs or are victims of abuse, neglect or exploitation. County APS agencies investigate reports of abuse of elders and dependent adults who live in private homes, apartments, hotels, hospitals, or who are, or soon will be, experiencing homelessness.
To report abuse, call (833) 401-0832 and when prompted enter your five-digit ZIP code to be connected to the Adult Protective Services in your county, seven days a week, 24 hours a day.
Contact your local county APS Office to report elder abuse or dependent adult abuse. Abuse reports may also be made to your local law enforcement agency.
Call the California Department of Aging’s Long-Term Care Ombudsman CRISISline at (800) 231-4024. The CRISISline is available 24 hours a day, seven days a week, to receive complaints from residents residing in long-term care facilities.