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



The MIA does not publish regular reports directed specifically at consumers including comparative health insurance complaints data, similar to most of the other states in this study. In April 2000 the MIA issued a report focussing specifically on the operation of the new appeals and grievance law, but it has not published broader complaints data. In addition, the HEAU is required by law to issue an annual report on the Maryland appeals and grievance process, which includes a listing of the complaints filed against health plans.

In terms of plan-specific complaints information, the MIA noted that consumers were able to make formal Public Information requests but that consumers contacting the MIA with such a request tended to be referred on to the HEAU. HEAU staff noted that it received about 2-3 calls daily during the annual enrollment periods from consumers interested in the complaints history of specific plans. Staff have the ability to call up on screen aggregate data on complaints of individual insurance plans and can provide information to callers on the type of complaints received and how they were resolved. However staff of the HEAU are cautious in interpreting this information to consumers as "good" or "bad", as the database does not allow this material to be presented relative to the volume of business of the insurance company. The data include all complaints, with no attempt made to distinguish between "justified" and "not justified" complaints. The HEAU is installing a new complaints database which will assist staff in providing greater textual interpretation when they receive inquiries concerning complaints histories of individual insurance plans.

The MIA reports complaints data to the NAIC CDS for national tracking of complaints.

Two reports relevant to Maryland complaints management are available:

  1. The Maryland Health Care Commission Comparing the Quality of Maryland HMOs 1999 Consumer Guide (Attachment 2); and
  2. The Maryland Insurance Administration's 1999 Report on the Health Care Appeals and Grievance Law, April 2000 (Attachment 3). The required annual HEAU report on the appeals and grievance process is included as Appendix B of the MIA report.

For each of 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.