DMHC Consumer Assistance

The Department of Managed Health Care (DMHC) maintains a program that assists consumers with resolution of problems and complaints involving HMOs. Members are advised of the DMHC requirements in 12-point bold type in their Evidence of Coverage (EOC), on the Health Net Member Grievance Form (PDF), on the appeal form, and on all correspondence and notices relating to complaints.

If the grievance involves an immediate and serious threat to the member's health, the member may seek immediate assistance from DMHC. Participating providers may assist the member in submitting a complaint to the department for resolution and may advocate the member's cause before the department. No participating provider may be sanctioned by Health Net or by a participating physician group (PPG) for giving such assistance to a member.

Online Complaint and Independent Medical Review Application Form

In addition to submitting required paperwork and forms via mail or fax, DMHC launched a secure online form to allow members to file complaints regarding their health plan electronically. The portal is available in both English and Spanish and enables consumers to request an external review of Health Net's denial of medical services, through Independent Medical Review (IMR). The Online Complaint and Independent Medical Review Application Form, can be accessed through the DMHC website. To obtain additional information regarding IMR, refer to Dispute Resolutions and Appeals > Member Appeals > Appeals Process.