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


The three major sources of complaints data available to the public are:

  1. The Texas Internet Complaints Information System (ICIS), an electronic database maintained by the TDI;
  2. "Comparing Texas HMOs" Annual Reports, published by OPIC using TDI data; and
  3. Insurance Company and HMO Profiles available on the TDI internet site.

In brief, ICIS is the primary source of all insurance complaints received by TDI and is a searchable database accessible to the general public. It is believed that Texas is the only state to provide such complete access to complaints data. While consumers can use ICIS to generate a limited set of standard complaints reports electronically, TDI has not invested in the production of educational or interpretive consumer complaints reports.

The OPIC "Comparing Texas HMOs" Annual Reports are broadly similar to comparative complaints reports produced by several other states in this study including Oregon and New York, containing complaint indices for individual HMOs based on premium volume, to allow comparison shopping by potential HMO consumers. Finally the Insurance Company and HMO Profiles, available electronically on the TDI web site, contain company-specific information, including complaints reported to TDI by consumers and providers.

Copies of standard reports able to be generated by ICIS and examples of TDI plan-specific information, together with the published OPIC reports, are attached to this study (Attachments 2- 5). For each of these sources or 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.