Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Background


In 1999, the U.S. House of Representatives and the U.S. Senate passed legislation addressing patient protections under health care plans, with the bills still being considered in Conference Committee as at June 2000. This followed the passage of comprehensive patient bills of rights in some 39 states between 1994 and 1998, in response to growing consumer concerns. While there is a perceived managed care backlash, consumers generally report high satisfaction levels with their individual health care providers and plans, with limited quantitative data available on the comparative problems faced by people in indemnity health insurance and managed care respectively.

Accordingly the federal Department of Health and Human Services issued a Task Order seeking advice on “Consumer Protection in Private Insurance: State Implementation and Enforcement Experience”. This Task Order is in two parts as follows:

  1. Implementation Case Studies -- this part seeks to identify the lessons learned by states in implementing selected consumer protections; and
  2. Identification of Most Common Consumer Health Care Complaints.

This report is submitted in accordance with the second part of the Task Order, while a separate report will be submitted on state implementation case studies.

This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of selected states and major employers. Specifically, the study seeks to identify the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards” and to analyze complaints data as a tool in understanding the implementation of patient protections.