Health Insurance

30 What to Do if You Have a Problem with Your Policy Contact your health plan to resolve your problem. • Talk to your doctor and call your health insurer. Sometimes talking solves the problem. • You can file a complaint with your health plan. A complaint is also called a grievance or appeal. • Generally, your insurance company must make a decision within 30 days. • If your health problem is urgent, your health insurance must do an Expedited Review. It must be done as soon as possible, in 72 hours or less. If you are not satisfied with your health plan’s review process or decision, call the California Department of Insurance (CDI). You may be able to file a complaint with CDI or another government agency. If your policy is regulated by CDI, you can file a complaint at any time. The CDI reviews cases that involve: • Disagreements about the services your health plan must cover. • Termination or cancellation/rescission of your insurance policy. • Exclusions and limits on services that are usually covered. • Timely access to medical care.