California Medical Association

Tuesday, February 21, 2017

Dispute Resolution

As a patient and a consumer, there may be times when you're dissatisfied with the care you are receiving—whether by a personal physician, hospital, or your own health plan. It's important to try to resolve a problem, particularly when it affects your health. Depending on your issue, there are many independent organizations that can assist in difficult situations.

Physician Disputes

The San Francisco Medical Society can assist in mediating disputes between patients and individual physicians. The Professional Relations & Ethics Committee of the San Francisco Medical Society serves the public by mediating complaints between patients and their physicians.

If you are experiencing difficulties concerning medical care or are experiencing ethical issues with a San Francisco physician (MD/DO only), please contact Steve Heilig at (415) 561-0850 or heilig@sfms.org. A complaint must be filed in writing. We will send you a complaint form to fill out or you can print one out here; either will require your signature for release of medical information pertinent to your complaint. The physician will be notified of your complaint. Our Professional Relations & Ethics Committee will then review your complaint and inform you in writing of its recommendations.

Please note: This is a confidential, peer-review advisory process; disciplinary action can only be taken by the Medical Board of California (MBC). To file a complaint with the MBC, call (800) 633-2322. You can also visit its website at http://www.mbc.ca.gov/Consumers/Complaints/ for additional information.

Hospital and Inpatient Facilities

The Department of Health Services licenses hospitals and nursing homes. Call the licensing division at (916) 445-2070 to verify that a facility is licensed. In addition, the department accepts complaints against facilities. To file a complaint, contact the DHS field office in the county where the facility is located. For sites in San Francisco, contact the Daly City field office at (415) 301-9971.

Health Plans

If you are having a problem with your insurance carrier or HMO, first write a letter to the health plan about your problem. If there is no response, you should then proceed with the plan's formal internal dispute process. If you then do not get resolution, and depending on what type of health insurance you have, there are two state agencies with which you can file a complaint against your health plan:

Department of Insurance (oversees traditional health insurance providers)
(800) 927-4357
45 Fremont Street, 23rd Floor
San Francisco, CA 94105

Department of Managed Health Care (regulates HMOs)

(888) 466-2219 (toll free)
(877) 688-9891 TDD
(916) 229-0465 FAX
HMO Help Center
980 Ninth St., Suite 500
Sacramento, CA 95814-2725

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