Ombuds Office
The Ombuds Office is an objective, independent resource that helps people who are experiencing issues with the health plan they have through Covered California.
When should I contact the Ombuds Office?
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 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 customers 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.
Helpful Resources
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 plans available in your area.
Applying for health insurance.
Reporting a change on your application.
Getting financial help.
Managing your account.
Obtaining your Form 1095-A or filing a dispute form for your Form 1095-A.
Answering questions regarding your 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.
Related Links
County Social Services Offices
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.
DHCS can help with any Medi-Cal concern, including:
Expedited plan enrollment, plan changes and plan disenrollment.
Access-to-care issues.
Ordering a Benefits Identification Card (BIC), if your local county office is unable to help.
Updating county codes (when consumers move to another county).
Referrals to appropriate agencies for concerns outside of their scope.
The DHCS Ombudsman Office can help if you are seeking to:
Navigate through the Medi-Cal Managed Care system.
Find information to help access mental health services.
Help members with urgent enrollment problems.
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.
Contact Information
Medi-Cal Helpline: (800) 541-5555.
DHCS Ombudsman Office: (888) 452-8609, or
Email: mmcdombudsmanoffice@dhcs.ca.gov.
Related Links
California Department of Health Care Services Website
County Social Services Offices
The Health Consumer Alliance (HCA) offers free legal advice and representation, including assistance with filing complaints and grievances and pursuing hearings. The HCA is a network of 10 consumer-assistance programs operated by community-based legal services.
HCA provides free legal assistance in any language to consumers who are having problems with:
Their health coverage.
Enrolling in a plan.
Eligibility.
Renewing their coverage.
Payment processing.
Disconnects between Covered California and Medi-Cal.
Using their coverage.
Affording insurance or services.
Obtaining timely services from any health care entity.
Contact Information
(888) 804-3536
Call 9:00 a.m. to 5:00 p.m., Monday through Friday. You will get a call back if you leave a message after business hours.
Related Links
Visit the Department of Managed Health Care (DMHC) Help Center if you have already filed a grievance with your health insurance company, or if there is an imminent threat to your health.
If you are experiencing an issue with your health plan or are having difficulty accessing care, you can file a grievance with your insurance company. If you are not satisfied with your health insurance company’s resolution of the grievance or have been in their grievance system for 30 days, contact the DMHC Help Center for assistance.
If you are experiencing an imminent or serious threat to your health, contact the DMHC Help Center immediately.
The DMHC Help Center can assist with the following types of complaints:
Cancellation of coverage.
Denials or delays of care or services.
Billing problems.
Quality of care.
Access problems, including not getting a timely appointment.
Issues with providers, medical groups and pharmacies.
Contact Information
DMHC Help Center: (888) 466-2219.
Related Links
California Department of Managed Health Care Website
DMHC Help Center
DMHC Independent Medical Review/Complaint Form
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 consumers in a timely manner, and that they deliver fair and equal benefits.
Contact CDI for any questions or concerns with the following:
Independent Medical Review applications (IMR).
Concerns with health insurance coverage or companies.
Licensing and other information for agents and brokers.
Health care coverage information for seniors.
Checking the status of an individual’s or agency’s license.
Resolving insurance-related consumer complaints.
Investigating and prosecuting insurance fraud.
Related Links
California Department of Insurance Website
CDI Consumer Resources
CDI Seniors Information Center
Check the license status for agents or brokers, or obtain insurance company information.
File a complaint or complete an Independent Medical Review application.
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.