California Parity Resources

Depending on whether you are filing a complaint or appeal, the contact information below should be able to help you if you have any questions.

For general information about filing a parity appeal for mental health or addictions services, you cannot go wrong with contacting one of the consumer advocates below. Each has years of experience helping consumers in the state of California.
CA Health Advocates: Medicare advocacy and education
Office of the Patient Advocate

When filing an appeal for the first time, you should contact your health plan’s customer service support line or check out their information online. If you choose to appeal an adverse benefit determination concerning your mental health or substance use treatment or benefits, please keep in mind that the timeframe to do so varies by state, plan type, and other factors. Contact your state’s department of insurance for additional information. Here is some contact information for California Health Plans:
Anthem Blue Cross
Call customer service listed on the back of your membership card. Submit a grievance form online Send the form to: Grievance and Appeals PO Box 4310 Woodland Hills, CA 91365-4310
Blue Shield of California
Call member services Appeals and grievances forms are here Mail or fax appeal or grievance forms to: Blue Shield of California Medicare Appeals & Grievances PO Box 927 Woodland Hills, CA 91365-9856
Chinese Community Health Plans (CCHP)
Call member services: 888-775-7888 Click here for online grievance form and information
Health Net
Call customer service Mail or fax appeal or grievance forms to: Health Net Appeals and Grievances Department PO Box 10344 Van Nuys, CA 91410-0344 Fax: (877) 713-6189 Submit online, click here
Kaiser Permanente of CA
Northern California (800) 443-0815 Southern California (800)556-7677 Complaint form available online, click here
L.A. Care Health Plan
Write, visit or call if you have complaints: Member Services Department 1055 W. 7th street, 10th Floor Los Angeles, CA 90017 888-839-9909 Click here for online grievance form
Oscar Health Plan of California
Grievance form click here Mail to: Oscar Health Plan of California Attention Grievances PO Box 278 New York, NY 10013 (800) 735-2929
Sharp Health Plan
Sharp Health Plan Grievances and Appeals 8520 Tech Way, Suite 200 San Diego, CA 92123 Fax: (619) 740-8572 File online click here
United Healthcare
Call HMO member services 800-624-8822 Call PPO member services 866-414-1959
Valley Health Plan
If you have a grievance call member services first: 888-421-8444 and use the Plan’s grievance process before contacting the Department of Managed Health Care (DMHC).
Western Health Advantage
Contact member services File online or download form here

Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725
(888) 466-2219
Fax: (916) 255-5241
Click here for online assistance
Insurance Commissioner
California Department of Insurance
Insurance Commissioner
300 South Spring Street, South Tower
Los Angeles, CA 90013
(800) 927-4357
Utilization Management
Department of Managed Health Care
Deputy Director
Department of Managed Health Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (916) 255-2405
Fax: (916) 255-5241
External Review
Department of Managed Health Care
Deputy Director
Department of Managed Health Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (916) 255-2405
Fax: (916) 255-5241
Parity Appeals
Department of Managed Health Care
Director
980 Ninth Street, Suite 500
Sacramento, CA 95814
(916) 322-2078

 

Additional California Insurance Administration Contacts, click here

The federal government also can be a helpful resource if you are enrolled in a self-funded plan, Medicare, Medicaid or another type of insurance that is overseen at least in part by a federal agency.

For definitions and filing information refer to the Parity Resource Guide

U.S. Department of Health and Human Service’s website on the Affordable Care Act health reform law

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)

(SAMHSA) Implementation Mental Health Parity Addiction Equity Act

U.S. Centers for Medicare and Medicaid Services (CMS)

U.S. Department of Labor, Employee Benefits, Security Administration (EBSA) or toll-free hotline: 1.866.444.EBSA (3272)

For the U.S. Department of Health and Human Services & Centers for Medicare and Medicaid Services list of exempt state and local plans, please email NonFed@cms.hhs.gov. You may ask them if any particular state and local plan has opted out of MHPAEA.

Information on requirements of employer-based insurance coverage and self-insured health plans.
EBSA has benefit advisors who are available to answer questions and provide assistance in obtaining your benefits.

Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits

Veterans and military personnel can use these resources to get help or more information with their medical or behavioral health complaints.

Health Net Federal Services

A grievance is a written complaint or concern about a medical provider.
Click here for specific information regarding who, what and how to file.

TRICARE

View the recently released Tricare Mental Health Fact Sheet.

The appeal process is different based on the benefit issue. Depending on your issue, you can file a:

  • Factual appeal
    • This is if you were denied payment for services or supplies you received, or if payment was stopped for services or supplies previously authorized.
  • Medical necessity appeal
    • This is if prior authorization for care or services was denied because it was not deemed medically necessary. Medically necessary means it must be appropriate, reasonable, and adequate for your condition.
  • Pharmacy appeal
    • This is if you don’t agree with a decision made about your pharmacy benefit. For example, Express Scripts denies your pharmacy claim.
  • Medicare-TRICARE appeal
    • This is if you’re eligible for both TRICARE and Medicare, and Medicare denies your services or supplies.

If your care is denied, you should receive a letter with details about how to file your appeal.

Veterans Health Administration

Complaints are initially handled through the Patient Advocate.
Patient Advocate can be contacted at your local VA Medical Center.

If you have any additional questions about parity compliance, please contact info@paritytrack.org

More Parity Information:

Please note: Parity Registry does not automate the appeals process. The information you provide may alert policymakers to possible health plan violations of the law, thereby helping to shape public policy and influence legislation.

You must take follow-up action with your health plan or regulatory agency.