Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 2. Public Education on Complaints


General education/outreach:

  • In terms of publicly available information on health insurance complaints, your web site currently lists the following information which is produced for consumers
  • (insert state-specific list of electronic brochures/reports);
  • (insert state specific list of brochures/reports listed on Web available in hard copy only).
  • Can you provide me with copies of brochures/reports not accessible through your Web site?
  • Do you actively publish information on complaints? How, and to what extent, do you undertake outreach on complaints publications?
  • Do you promote the availability of speakers who can talk to various groups about the complaints function managed by (name of State agency)? What is the demand?
  • To what extent does your Annual Report highlight the effectiveness of the complaints function? (Seek copy)
  • Does your Commissioner issue press releases publicizing the complaints function on a regular basis?
  • Do you require health insurance plans or HMOs to publicize the existence of your agency's complaints function? If so, when does this occur - at enrollment, at denial of services, other?

Plan-specific complaints information:

  • Do you provide information to consumers on request (specify whether requests can be oral or must be in writing) concerning the complaints performance of individual health insurance plans/HMOs? If so:
  • What information is provided in these reports to consumers?
  • What is the most common situation in which people are requesting information about specific plans? Is this when they are considering changing plans, when they have encountered problems themselves or some other situation?
  • Is this information provided free or is a charge made?
  • In your general inquiries intake, to what extent does there appear to be a demand for comparative or individual information on health insurance plans/HMOs? Is there a demand for information which you currently are not providing?