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Independent Medical Review, Arbitration, and Complaint Reports
The DMHC helps health plan members with problems getting the health care services they need. The DMHC has a searchable online database of Independent Medical Review (IMR) and arbitration decisions, as well as reports about complaints made against health plans.
IMR and Complaint Reports
Reporting to the public is an important part of the consumer services provided by the DMHC. Below is information about consumer complaints and, IMR and arbitration decisions.
IMR Decisions
The IMR program was created by the California Legislature and provides a vital service for California health plan members. In our database, you will find all IMR decisions since the program began on January 1, 2001.
Annual Reports
The DMHC publishes an annual report that details the number and types of complaints received during the calendar year, including IMR data.
Arbitration Decisions
When a health plan uses arbitration to settle disputes with its health plan members, the health plan is required to file a copy of the written arbitration decision with the DMHC within 30 days of the decision. The filed copy must include the amount of the arbitration award, if any, the reasons for the arbitration decision, and the names of the arbitrators. By law, the names of the health plan, health plan member, witnesses, attorneys, provider, health plan employees and plan facilities are deleted from the copy filed with the DMHC. These arbitration decisions are filed quarterly and every effort will be made to post these decisions on this site within the following quarter to be available to the public.