Ombuds Office

The Ombuds Office at Covered California is an objective, independent resource that helps consumers with problems or issues they have not been able to resolve after calling the service center, filing a complaint or filing an appeal.

If you have not tried to solve your problem through those methods, see the Helpful Resources section below for information on how to do so.

If we cannot help you, we will explain why we could not and will try to refer you to another resource.

When should I contact the Ombuds Office?

Contact the Ombuds Office for help if it has been more than 30 days since you submitted your complaint and you have not received an update, or you sought assistance from the service center but were still unable to resolve your issue.

You should also contact the Ombuds Office if you:

  • Want to learn about your appeal rights.
  • Want information about Covered California policies and procedures.
  • Need guidance for using our independent contractor, Health Consumer Alliance (HCA), which provides free legal advice and representation, including assistance filing a complaint or grievance and arranging a hearing.
    • Note: For more information on the services HCA provides, please see the Helpful Resources section below. Or, call HCA at (888) 804-3536.
    • Please note the Ombuds Office does not provide legal advice. 

Contact the Ombuds Office if the Service Center does not contact you or resolve your issue within the timeframes listed below.

If you contacted Covered California about:

Description

The service center should contact you in:

The service center should resolve the issue in:

Access to Care

(urgent)

Requires immediate care or medications.

(If this is a medical or psychiatric emergency, please dial 911.)

1–2 business days

5 business days

Access to Care

(non-urgent)

Medical treatments, appointments or prescriptions that are not life threatening, needed within 30 calendar days or less.

3 business days

15 business days

Lost Coverage

You lost coverage because of an error and need it to be reinstated.  

(This does not apply if your plan was canceled because you did not pay your premium.)

10 business days

30–45 calendar days

Issues With Your Proof of Coverage for Taxes

(Form 1095-A dispute)

Form 1095-A is a document you will receive from Covered California that is required to complete your income tax filing. You can file a dispute with Covered California if you think the information on your form is incorrect. File a dispute here.

10 business days

60 calendar days

Advanced Premium Tax Credit (APTC) Discrepancy

(financial help with your monthly premium)

Your APTC needs to be corrected or updated.

10 business days

30–45 calendar days

The Date Your Plan Coverage Starts (i.e., your Coverage Start Date)

You need to change the start date of your health plan enrollment.

10 business days

30–45 calendar days

Appeals-Process Questions

You filed a State Fair Hearing to appeal a Covered California issue and have not received initial contact, or you are waiting for a response from an appeals analyst regarding the appeals process. More information on how to file an appeal.

1–3 business days

Up to 90 calendar days

General Complaints

You filed a Covered California Complaint Form or have an issue for which you cannot file an appeal. See the full list of reasons for filing an appeal. Complaints involve issues such as problems with the website or Covered California staff.

1–5 business days

30 calendar days

Contact Us

Please download and complete our contact form and return it by email, fax or by mail.

You may also contact us directly:

  1. Email: ombuds@covered.ca.gov
  2. Call us toll free at (888) 726-0840 from 8 a.m. to 5 p.m., Monday through Friday (excluding state-observed holidays). Assistance is available in multiple languages.
  3. Fax: (888) 726-0841
  4. Mail:
Covered California
Attn: Ombuds Office
1601 Exposition Blvd. Sacramento, CA 95815
 

When contacting us, please include a summary of your problem, your Covered California case number (if you have one), a phone number and the best time for us to reach you.

We will do our best to help resolve your issue as quickly as possible (within 30 days for most cases). How long it takes us to research your case depends on how complicated your issue is. We will keep in touch with you along the way.

Helpful Resources