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



The Department's Consumer Services Bureau has 107 allocated staff, 34 of whom are clerical support staff. While some specialize in health insurance, others work across multiple lines of insurance business. In addition to its 1-800 hotline, the Department maintains offices in several cities including New York City, Albany, Buffalo and Mineola, all of which have a shop-front capacity to deal with consumers in person.

Volume of Business

The Department monitors web site hits and information calls to the Consumer Services Bureau. In 1999 the Consumer Services Bureau responded to about 450,000 telephone inquiries for information and received 67,186 complaints from consumers and providers across all lines of insurance business. Of the 52,737 complaints closed in 1999, 21,436 concerned accident and health insurance.

The Department also has dedicated toll-free lines for specific issues - the New York State Partnership for Long Term Care and Prompt Pay Complaints. In 1998 the Consumer Services Bureau responded to about 6,400 calls about the Partnership which allows individuals to qualify for Medicaid after their long term care policy benefits are exhausted, without divesting themselves of their assets. The Prompt Pay Law took effect as of January 1998 and requires all health insurers to pay undisputed health insurance claims within 45 days of receipt. Since the law took effect the Department has handled over 40,000 prompt pay complaints, with fines to insurers in 1999 of more than $266,000. Other toll-free lines include the disaster line, the multi- lingual line and the external appeal line.

Financial Savings to Consumers

The Insurance Department does not track financial savings to consumers with regulators commenting that it is unclear whether this information is particularly useful. For example, regulators noted that many consumers want information on whether they are treated properly and this may not result in additional financial savings to consumers. Regulators believe that measuring complaints only by $ returned to consumers understates the breadth of the role that the Department performs for consumers.

External Audit

There are two types of audit. The Office of the Controller audits all state government agencies. This report is given to the Insurance Department for comment, goes to the Superintendent/Governor and is publicly available, including receiving media coverage in the newspaper. There is also an internal control officer who audits the Department, including the Consumer Services Bureau.

Consumer Satisfaction Surveys

The Insurance Department has not yet undertaken consumer satisfaction surveys of people using its complaints function. It is building an "imaging system" which will involve paperless management of complaints. Under this system there will be the capacity to generate consumer satisfaction surveys. There is no view yet as to what form such surveys might take (e.g. postcard or telephone surveys).