Consumer Information for Complaints about Health Care Professionals, Facilities, and Programs

Publications
#5287.01

Sometimes, you may need to complain about health care providers, programs, facilities, or services. This pub has lists of agencies in charge of dealing with your complaint. It has a list of advocacy groups that can help you. It tells you where to find out more about your right to complain.

This publication may be helpful to you if you need information or have a complaint regarding health care providers, programs, facilities, or services you have received.  We have listed the government agencies with specific responsibility for addressing complaints first.  We have also included a list of some of the advocacy organizations and sources of information about your rights that may also be helpful.

INTRODUCTION

Health and residential care in California is regulated by many different agencies.  Below is a brief summary of the agencies which regulate health care services. People often use confusing acronyms or nicknames to identify these organizations so we have included them in bold also.

Most health-related professional services delivered by clinicians are regulated by the California Department of Consumer Affairs (DCA), and the licensing divisions or “Boards” pertaining to the type of service.  These include the Board of Medical Examiners, the Board of Dentistry, the Board of Psychology, the Board of Behavioral Services, the Board of registered Nurses and others.  Some of them are listed below.  All of the types of professionals licensed by the Department of Consumer Affairs are listed on its website. click here for DCA's website

Hospitals, clinics, and nursing homes including subacute facilities are licensed and regulated by the California Department of Public Health (CDPH). General complaint information and links for specific complaints are found at click here for CDPH's website

The Community Care Licensing (CCL) Division of the California Department of Social Services (CDSS) licenses and regulates most residential, day and child care services.  Residential care facilities include board and care homes, community care facilities (CCFs), residential care facilities for the elderly (RCFE) and assisted living facilities. click here for CCLD's website

Private or commercial managed care plans are regulated by the California Department of Managed Health Care (DMHC). click here for DMHC's website

Medi-Cal, Denti-Cal, and Mental Health care, whether managed care or fee-for-service, are regulated by the California Department of Health Care Services (DHCS). click here for DHCS' website

Many Medi-Cal managed care plans are licensed by DMHC and therefore the consumer protections available in private or commercial plans are also available to Medi-Cal beneficiaries.

There are no DMHC licensed plans under Denti-Cal, county Mental Health Medi-Cal Managed Care, and, except for the San Mateo county health plan, County Operated Health Systems (COHS) covering Medi-Cal recipients in the following counties:  Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, Santa Barbra, Sa

Several agencies such as the Department of Health Care Services (DHCS) and the California Department of Public Health (DPH) have an “Ombudsman” office which is an office assigned to answer consumer questions and to resolve complaints.  In addition, there is an independent long-term care Ombudsman program to help persons in nursing and other health facilities and in residential care facilities.

Private health insurance plans not involving managed care, including many Preferred Provider Organizations or PPOs and some other insurance plans, are regulated by the California Department of Insurance (CDI). click here for CDI's website

Compliance with the consumer protections required under the Affordable Care Act (ACA) is enforced by Covered California, the Department of Managed Health Care and the Department of Insurance.  Examples of ACA consumer protections include covering children under a parent’s policy to age 26, elimination of lifetime cost caps, and coverage of preventive care without copay or deductible.

Medicare is regulated primarily by the Center for Medicare and Medicaid Services (CMS) click here for CMS' website

Medicare Supplemental Insurance or MEDIGAP coverage is administered in California through the Department of Insurance (CDI). click here for the MEDIGAP coverage page on CDI's website

There are also other government agencies, advocacy organizations and other sources of consumer information for Californians about healthcare services, rights and complaints and other options.

Below are specific contacts for these and other agencies and some of the advocacy organizations and sources of information which you may find useful if you have concerns about your health care.  We have included most of the main websites as well as a link to the complaint departments.  The complaint forms can be found on these websites and will be kept up-to-date by the agencies or organizations.

If you need assistance finding the appropriate reference online, don’t have a computer or printer and need a hard copy of the complaint forms, or have other questions, please call the agency toll free number for information and help filing a complaint if that is what you decide to do.

You can also call Disability Rights California at 800-776-5746 about your health care services problems.  There are usually multiple ways you may address a health care services problem as illustrated in the problem examples included at the end of the enclosed charts.   For all TTY calls to DRC, dial 800-719-5798

HEALTH PLANS AND HEALTH CARE SYSTEMS

Managed Care Plans

Department of Managed Health Care (DMHC)
DMHC Help Center
888-466-2219
DMHC's homepage
The ‘File A Complaint’ page on DMHC's website

Medi-Cal Managed Care Plans

Department of Health Care Services (DHCS)
Medi-Cal Ombudsman
888-452-8609
Email: MMCDOmbudsmanOffice@dhcs.ca.gov

The ‘MMCD Office of the Ombudsman’ page of DHCS' website

General information:
The general MMCD page of DHCS' website

Veterans Health and Attendant Care Benefits

Veteran’s Administration (VA)
877–327-0022
800-877-8339 (TTY)
VA's website

CalVet for assistance in accessing both VA benefits and California veterans’ benefits:
Local Cal Vet Service Officers: 844-737-8368
The Local Cal Vet Service Officers webpage

Find your local Disabled American Veterans (DAV):
The ‘Find Your Local Office’ page of the DAV website

Paralyzed Veterans of America
Benefits Helpline:  866-734-0857; TTYY 800-795-4327
Medical Services Healthcare Helpline: 800-232-1782
The ‘Veterans Benefits’ page of the Paralyzed Veterans of America website

Veteran Aid Organization: 
866-584-7191

Help in applying for Aid & Attendance and other benefits: 
The 'Apply' page of the Veteran Aid Organization website

Medi–Cal Eligibility and complaints at County Level

Department of Social Services (CDSS)
916-636-1980
Medi-Cal Eligibility
The Medi-Cal Eligibility Contacts page on the DHCS website

Contact County Dept. of Social or Human Services - see link for local numbers
The 'County Offices to Apply for Health Coverage, Medi-Cal, and Other Benefits' page of DHCS website

Medicare

Centers for Medicare and Medicaid Services (CMS)
877-267-2323

The Centers for Medicare and Medicaid Services website

Filing complaints about your Medicare health or drug plan:
The 'Filing Complaints about your Health or Drug Plan' page on the Medicare website

Medicare identified California resources:
The 'Find Someone To Talk To' page on the Medicare website

The 'Appeals and Grievances' page of the CMS website

Medicare, Medi-gap, Long Term Care

California Dept. of Aging
800-510-2020
The 'Where to Call for Services' Page of the CA Department of Aging website

California Dept. of Insurance re Medicare supplemental plans.  Consumer Hotline 800-927-4357.
The California Department of Insurance 'Guide to Medicare Supplement' website page

Long-term Care Ombudsman Crisis Line
800-231-4024

Health Insurance Counseling and Advocacy Project (HICAP)
800-434-0222
The 'HICAP' webpage on the California Health Advocates site

Mental Health Care

California Department of Health Care Services
(DHCS)
Mental Health Ombudsman
800-896-4042
800-896-2512-TTY
Email: MHOmbudsman@dhcs.ca.gov
The 'Mental Health Ombudsman's Services' page on DHCS' website

Health Insurance

State Dept. of Insurance
California Insurance–Getting Help
800-927-4357

The 'Getting Help' page of the CA Department of Insurance website

The CA Department of Insurance 'Consumer Complaint Center' log-in page

HOSPITALS, NURSING HOMES, RESIDENTIAL AND OTHER INSTITUTIONS, FACILITIES & SERVICES

Hospitals, Medical Clinics, Home Health Agencies, Home Health Aides, Nursing Assistants, Nursing Homes

California Dept. Of Public Health (DPH)
Licensing and Certification Program
Health Facilities/Consumer Information Systems
916-552-8700
800-236-9747

General Licensing Information: The 'Licensing and Certification Program' page on CA Department of Public Health's website

Complaint filing information: The 'Complaint Against a Health Facility/Provider' page on CA Department of Public Health's website

In addition to State Licensing, many health facilities and providers are also accredited and certified by the Joint Commission on Accreditation of Healthcare Organizations - JCAHO. The Joint Commision 'About' webpage

Report about a patient safety event or concern about a health care organization: 'Report a Patient Safety Event' Complaint page on The Joint Commission site

Go here to check on a health care organization’s accreditation and certification status: The Quality Check website
630-792-5800

Cemeteries and Funeral Establishments

Dept. of Consumer Affairs (DCA)
Cemetery and Funeral Bureau
800-952-5210
(916) 574-7870
'Complaints' page on the Department of Consumer Affairs Cemetary and Funeral Bureau site

Long Term Care/ Nursing Homes

See above about filing a licensing complaint or a complaint with The Joint Commission.
Long-term Care Ombudsman
800-231-4024
The 'Long-Term Care Ombudsman Program' page on CA Department of Aging website

Pharmacy

Dept. of Consumer Affairs (DCA)
CA State Board of Pharmacy

Consumer inquiries or about filing a complaint:  916-574-7900

Filing a complaint against a pharmacy: 'Filing a Complaint' on the CA State Board of Pharmacy website

If you run into a problem with a local pharmacy that is part of a chain, call the chain headquarters.

In Medi-Cal cases, almost any drug that is medically necessary can be covered with plan or Medi-Cal authorization if not on the formulary of drugs covered without prior authorization. If you are told that “Medi-Cal does not cover” a prescribed drug, that is usually incorrect.  Ask for help from your doctor and the pharmacy to get authorization.

Community Care Facilities, Child Care, Residential homes, Adult Day Care

California Dept. of Social Services (CDSS)
CA Department of Social Services website

Community Care Licensing Division (CCL)
844-LET US NO
844-538-8766
ccld.ca.gov/
The 'Community Care Licensing Division' page on the CDSS site

CLINICIANS AND LICENSED HEALTH CARE PROVIDERS

Counselors – Marriage/Family/Child Counselors /Therapists (LMFT/), Clinical Social Workers (LCSW), etc.

California Dept. of Consumer Affairs (DCA)
Board of Behavioral Sciences
916-574-7830
916-445-4933
The CA Board of Behavioral Sciences website
The 'Consumer Complaints' page on the BBS website

Doctors, Physician Assistants (PAs) and Other Medical Assistants and Health Personnel

Medical Board of California
800-633-2322
916-263-2424
The Medical Board of California's website
The 'Consumer Information' page on the CA Medical Board website

Optometry

Dept. of Consumer Affairs (DCA)
CA State Board of Optometry
optometry@dca.ca.gov
916-575-7170
866-585-2666
The CA State Board of Optometry website
The Complaints page on the CA Department of Consumer Affairs BreEZe Online Services

Psychologists (PhD, PsyD) and Psychological Assistants

Dept. of Consumer Affairs (DCA)
California Board of Psychology
866 – 503 -3221
The DCA Board of Psychology website
'Filing a Complaint' webpage on the DCA Board of Psychology site

Regional Centers and Regional Center Vendors

Department of Developmental Services (DDS)
General Information: 916-654-1690
Hearing Impaired: 916-654-2054
The DDS website

Find your local regional center at
The 'Regional Centers Directory' on the DDS website

Registered Nurses, Nurse Practitioners, Nurse Midwives , etc.

Board of Registered Nurses (BRN)
(916) 322-3350
TTY: (800) 326-2297
California Board of Registered Nursing website
'The Complaint Process' page on CA BRN website

Speech Pathologists (SPL)

California Dept. of Consumer Affairs (DCA)
Speech Language Pathology & Audiology & Hearing Aid Dispensers Board
916-263-2666
The DCA Speech Language Pathology & Audiology & Hearing Aid Dispensers Board website
'Complaint Process' page of the DCA Speech and Hearing Board website

Vocational Nurses and Psychiatric Technicians

California Dept. of Consumer Affairs (DCA)
Board of Vocational Nurses and Psychiatric Technicians
916-263-7827
The DCA Board of Vocational Nurses and Psychiatric Technicians website

Filing a complaint against a LVN or PT:
'How to File a Complaint' page on the BVNPT website

Dentists (DDS)

California Dept. of Consumer Affairs (DCA)
Board of Dental Examiners
916-263-2300
The DCA Dental Board of California website

Consumer complaints:
The Dental Board of CA's 'Consumer Complaint Form' PDF document

ADVOCACY, ADVICE, AND INFORMATION

Advocacy, Legal Counseling, and &/or Legal Referrals

Disability Rights California (DRC)
800-776-5746
Disability Rights California website.

On banner across the top, click on “Publications” for information on Medi-Cal and health care rights among other topics.

DRC’s Office of Clients’ Rights Advocacy (OCRA)

Provides free legal information, advice and representation to regional center clients: The Office of Clients' Rights Advocacy page on the DRC website

LawHelp.org
The LawHelpCA website

An interactive website of The California State Bar and Legal Aid Association of California that identifies legal assistance or advice options by geographic area and subject matter.

Legal Aid Association of California
The Legal Aid Association of California website;

On the right side of the website under “select a region,” click on a region for a list of legal services programs in that area.

Health Consumer Alliance – help to consumers on Medi-Cal, Covered California health plans, and more
The Health Consumer Alliance website – Click on “local help centers” for your local HCA contact information.

Click on “publications” for HCA’s excellent written materials

HCA Consumer Hotline
888-804-3536

Medicare Advocacy

California Health Advocates
Call HICAP for an individual appointment:
800-434-0222
HiCAP offices by county: http://cahealthadvocates.org/hicap/
Consumer information: California Health Advocates' 'Medicare Basics' webpage

Nursing Homes

California Advocates for Nursing Home Reform (CANHR)
916-322-3350
The CANHR website

Website information on Medicare, Medicaid, veterans, elder law and elder abuse and referrals to private attorneys for reduced rate initial consultations

Western Center on Law & Poverty -
Western Center on Law & Poverty's website
The '2016 Health Care Eligibility Guide' page on the WCLP website

Back-up center that does not provide direct representation or consumer advice; website a good source of information including 2016 advocates manual “Getting and Keeping Health Care Coverage for Low-Income Californians.”

National Health Law Program - NHeLP
The NHeLP website – under issues, click on California and then search for “Medi-Cal.”

Back-up center that does not provide direct representation or consumer advice; website a good source of information

Justice in Aging
The Justice in Aging website

Backup center that does not provide direct representation or consumer advice but is good source of materials about addressing common problems in nursing homes:
Justice in Aging's '20 Common Nursing Home Problems and How to Resolve Them' page

Medicare Rights Center -
About National Helpline 800-333-4114
The 'Contact Us' page on the Medicare Rights Center site
The Medicare Rights Center website

Check out the website’s online “Medicare Interactive” online reference tool.

Website a source of information plus a multi-lingual helpline for consumers.

Family Care Givers Caring for Brain Impaired Adults
Re: Care Giver Resource Center:
800-445-8106
The 'California's Caregiver Resource Centers' page on the Family Caregiver Alliance website
The 'Contact' page of the Family Caregiver Alliance - National Center on Caregiving website

Alzheimer’s Disease and Related Disorders
Alzheimer’s Assoc. chapters
The Alzheimer's Association website
800-272-3900 – national

The 'Alzheimer's Disease Program' page on the CA Department of Public Health website

800-660-1993 – to locate a local chapter
Links to California Chapters:
The 'In My Community' search page on Alzheimer's Association website

The 'Alzheimer's Association Chapters' webpage

Civil Rights

U.S. Department of Health and Human Services (HHS)
Office of Civil Rights
800-368-1019
The HHS Office of Civil Rights website
'Filing a Civil Rights Complaint' page on the HHS Office of Civil Rights website

In addition, each county has an office of civil rights, when you call the county, ask for that unit.

If you are dissatisfied with the results of a civil rights complaint filed with the county, and the complaint is about a state and/or federal program overseen by either the Department of Health Care Services or the Department of Social Services you can appeal the complaint filed with the county to DSS or DHCS.

Department of Health Care Services’
Office of Civil Rights – 916-440-7370
The CA Department of Health Care Services' "DHCS Language Access Discrimination Complaint Process" PDF document

Department of Social Services’
Offfice of Civil Rights – 916-654-2098
The HHS Department of Social Services' "Your Rights: Under California Welfare Programs" pamphlet PDF

Or you can file a complaint initially with either state department.

Fire Safety Laws

Office of State Fire Marshall
916-445-8200
The Office of the State Fire Marshal website

Medi-Cal Fraud

Department of Health Care Services (DHCS)
800-822-6222
DHCS' website's 'Stop Medi-Cal Fraud' page

California Attorney General (CAG)
800-722-0432
'Medi-Cal Fraud' page on the CA Department of Justice Office of the Attorney General website

Medicare/Medicaid Fraud

US Dept. of Health and Human Services (HHS)
Office of Inspector General
800–700–5952
The Office of Inspector General HHS website

HIV

AIDS Hotline
800-367-2437
'State HIV/AIDS Hotlines' information page on the Health Resources & Services Administration website

Social Security

Social Security Administration (SSA)
800-772-1213
The 'Contact Social Security' page on the SSA website