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

06/01/2000

Introduction

The Insurance Division produces (or disseminates) three different reports containing complaints data:

  1. Consumer Guide to Oregon Insurance Complaints (Attachment 1);
  2. Oregon Complaint Report Part II (Attachment 2); and
  3. Insurance Company Annual Reports (Attachment 3).

In brief, the Consumer Guide to Oregon Insurance Complaints is the annual complaints "report card" providing comparative complaint indices and rankings, organized by line of business, including health insurance plans and Health Care Service Contractors (HCSCs). The Part II report provides a more detailed listing of all consumer complaints filed against every insurance company with the type and disposition of each complaint, but is not designed as a comparative report. The Insurance Company Annual Reports are prepared by health plans, as a requirement of the Patient Protection Act 1997, and include grievance statistics, utilization review summaries, quality assessment summaries and scope of network summaries. These reports are available on the Insurance Division's internet site for individual plans, with no summary report available across all plans.

For each of these reports this study describes the major features, analyzes the data, and assesses the usefulness of the report from both the perspective of consumer friendliness and its value in monitoring the implementation of patient protection legislation.