Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. E. Agency Performance Issues



In the DHCA there is one Consumer Services Specialist with responsibility for the Hotline, although consultation may occur with other staff as required for guidance, including legal staff.

The Ombudsman Office has a total of 4 and 1/2 staff, together with the Ombudsman. These staff cover all issues, including providing the Medicaid Ombudsman services.

Financial Savings to Consumers

In the DHCA complaints resolution resulted in $137,675.08 being collected from insurance plans in 1997/98.

The Ombudsman Office does not collect data on financial savings to consumers.

External Audit

It is believed that the DHCA is subject to audit by the State Auditor, including its management of the contract with the Ombudsman Office. However the Ombudsman Office is not audited directly by the State Auditor.

Consumer Satisfaction Surveys

The DHCA does not send out consumer satisfaction surveys to its Hotline callers.

The Ombudsman Office undertakes regular consumer satisfaction surveys (Attachment 6) which commenced in Fall 1999. They send a survey out for every closed complaint, providing a stamped self-addressed envelope in order to ensure confidentiality and to make it easier for consumers to respond. When they started in Fall 1999, they sent surveys to all the consumers who had used the program until that time, and did not get such a good response rate because of the time lag. Now, however, surveys are sent out regularly and it is likely that the response rate has improved. The Ombudsman receives quarterly reports including the tally of returned surveys and aggregate consumer satisfaction data. In addition, the Ombudsman personally reviews any surveys immediately where the consumer has expressed dissatisfaction with the service they received from the Office.