Medi-Cal Managed Care: An Independent Medical Review (IMR) Can Change a Plan’s No to Yes

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#5534.01

I have Medi-Cal managed care. What options do I have if my health plan denies a service?

Most Californians who get Medi-Cal are in managed care through a Medi-Cal health plan. Health plans are also called managed care organizations or health maintenance organizations.

    ou have several options if your Medi-Cal health plan denies a service, so don’t give up! Here are some of the steps you can take:

    • File a grievance or appeal with your health plan.
    •  Ask for an Independent Medical Review (IMR) or a Department of Managed Health Care (DMHC) Complaint. Note: This publication focuses on IMRs.
    • Ask for a state hearing from the Department of Social Services.

    For general information on Medi-Cal managed care plans, see Disability Rights California’s publication on Medi-Cal Managed Care Health Plans. What are they? What do I need to know about them? Available at http://www.disabilityrightsca.org/pubs/549501.pdf.

    The Department of Health Care Services oversees the Medi-Cal program and Medi-Cal managed care plans, but the DMHC handles IMRs (and complaints)...

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