Complaint Reports

Once a year, the Department of Managed Health Care (DMHC) prepares a report on complaints and Independent Medical Reviews (IMRs). You can read these reports by clicking on the link below.

Arbitration Decisions

Arbitration is a way to solve disputes, disagreements, or problems between health plans and patients without filing a formal lawsuit. In arbitration, an independent person or several people settle the dispute. It does not go to a judge or jury. Arbitration is usually less expensive and takes less time than a lawsuit.

Most health plans require binding arbitration. This means that both the patient and the health plan must accept (be bound by) the decision of the arbitrator. Neither can appeal the decision.

If a plan requires binding arbitration, the plan must file a copy of any written arbitration decision with the DMHC within 30 days of the decision.

The copy of the decision must include the amount of the award, the reasons for the award, and the names of the arbitrators. By law, the names of the plan, the member, the doctor or other provider, and the witnesses, attorneys, plan employees, and plan facilities are removed from the copy filed with the DMHC. The public can Search and View Arbitration Decisions.