Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. E. Agency performance measures



In the TDI Consumer Protection Program complaints unit, staff are split by insurance line, with 20 staff handling life, health and accident insurance complaints. The 20 staff include both intake/administrative staff and case workers/insurance specialist staff. The TDI HMO/URA Division has 17 staff in the Quality Assurance section which handles complaints. Staff are assigned complaints according to topic; for example, access and quality complaints will be assigned to registered nurses, while contractual issues will be assigned to insurance specialists.

OPIC currently has a total staff of 18 (down from 19 in the previous legislative session) with a mix of staff working either full-time on health insurance or working across multiple insurance lines. There are 2.5 full-time equivalent staff working on health and HMO report card issues. The significance of the HMO report card to OPIC's activities is also measured by the fact that 14% of total salaries are paid from the Consumer Education appropriation which consists solely of the report card project.

Volume of Business

Measures of demand for the Consumer Protection Program of TDI include:

  • Number of inquiries - 347,000 in 1999, up from 284,500 in 1996;
  • Calls handled by information assistance - 326,000 in 1999, up from 250,000 in 1996;
  • Written complaints - In FY 99 complaints resolution staff resolved more than 22,700 complaints out of the 32,571 resolved agency-wide.
  • Website hits to TDI - 162,000 in 1999 with the most frequently accessed items being the Company Profiles, the rate guides and the ICIS database.

Financial Savings to Consumers

TDI staff noted at interview that intervention by TDI had resulted in about $25m financial savings to consumers across all insurance lines of business in 1999.

External Audit

TDI is subject to external audit through the state auditor's office which measures performance against agreed parameters. In addition, there is a new "Compact with Texans", the purpose of which is for all state agencies to establish customer service standards.

The Consumer Protection Program undertakes internal audit on every complaint file to verify that correct procedures were followed. The Life, Health & Licensing Program undertakes monthly internal audits, comprising a random sample of complaints closed in the previous month. These complaints are reviewed against an audit form as to whether they meet the coding standards. TDI staff noted that there was a strong focus on audit within the agency.

Consumer Satisfaction Surveys

The TDI works in conjunction with a local university to conduct biennial written consumer satisfaction surveys, with the next survey scheduled to occur in about mid-2000.