Covered California Ombuds Office

The Covered California Ombuds Office is an independent and objective resource that helps individuals resolve problems related to their Covered California health and dental insurance plans.

The Ombuds Office assists consumers who have already attempted to resolve their issue through Covered California’s regular customer service and complaint processes but still need additional support. The Office reviews concerns, researches cases, helps identify possible solutions, and explains why a resolution may or may not be possible.

The Ombuds Office does not replace Covered California’s existing customer service, complaint, or appeal processes. Instead, it provides an additional level of support for more complex issues that have not been resolved through regular channels. 

In this OmbuDesk Directory entry, you can find information about the Covered California Ombuds Office and how to contact them.

What is the Covered California Ombuds Office?

The Covered California Ombuds Office is a health insurance dispute resolution resource that helps consumers with unresolved concerns regarding their Covered California health or dental insurance plans.

The Ombuds Office provides an impartial review of consumer concerns and helps individuals understand available options for resolving problems with their coverage. 

What does the Covered California Ombuds Office do?

The Ombuds Office can:

• Review concerns regarding Covered California health and dental insurance plans.

• Research cases and review previous attempts to resolve the issue.

• Help consumers identify possible solutions.

• Explain why a resolution may not have been reached.

• Assist with communication between consumers and Covered California.

• Provide additional support for complex cases.

Who can ask for help?

Individuals with a Covered California health or dental insurance plan who are experiencing unresolved issues may contact the Ombuds Office.

This includes consumers who:

• Have already contacted the Covered California Service Center.

• Have completed the escalation process.

• Have filed a Covered California complaint and have not received an update after more than 30 days. 

What kinds of problems can you bring?

You can contact the Ombuds Office about concerns involving:

• Health insurance enrollment issues.

• Dental insurance enrollment issues.

• Application problems.

• Problems with an existing Covered California plan.

• Issues that remain unresolved after contacting Covered California customer service.

• Concerns that have gone through the regular complaint process without resolution. 

What doesn’t the Covered California Ombuds Office do?

The Ombuds Office does not:

• Replace the Covered California Service Center.

• Handle simple inquiries that can be resolved through regular customer service.

• Provide legal advice.

• Provide legal representation.

• Replace formal appeals or complaint procedures.

• Resolve Medi-Cal eligibility issues handled by county offices.

• Guarantee a specific outcome.
  
  
  If a matter requires legal advice or representation, Covered California refers consumers to the Health Consumer Alliance, which provides free legal assistance for eligible health coverage issues.

Jurisdiction, Authority, and Limits

The Covered California Ombuds Office helps resolve issues related to Covered California health and dental insurance plans.

Before contacting the Ombuds Office, consumers must first:

• Contact the Covered California Service Center.

• Complete the available escalation process, or

• File a complaint and wait more than 30 days without receiving an update. 

The Ombuds Office does not have authority to:

• Replace existing Covered California complaint, appeal, or customer service processes.

• Provide legal decisions.

• Act as a legal representative.

• Resolve matters outside Covered California’s authority. 

How can you contact the Covered California Ombuds Office?

You can contact the Ombuds Office after completing the required steps through Covered California’s contact form.

Before contacting the Ombuds Office:

Telephone:

(800) 300-1506

Covered California Service Center hours:

Monday to Friday: 8:00 a.m. to 6:00 p.m.

To open a case with the Ombuds Office, submit the Covered California Ombuds Office contact form online. You should have your:

• Case ID number.

• Reference number provided by the Service Center.