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D. Public Education Activities

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. D. Public Education Activities

Publications In addition to the toll-free line, the DHCA publishes a range of reports relevant to health insurance including:
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C. Complaints Reports and Data

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

Neither the DHCA nor the Ombudsman Office publish complaints "report cards", comparing the complaints performance of individual plans. DHCA
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B. Jurisdiction and Liaison with Health Plans

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. B. Jurisdiction and Liaison with Health Plans

The Division of Health Care Administration, BISHCA When the DHCA receives a complaint about ERISA plans, it sends out a letter as though they are able to be regulated. Generally, these entities respond in a similar manner to regulated plans, with no-one ever refusing to respond because of the lack of regulatory authority by the DHCA for thes
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A. Jurisdiction and Responsibility for Consumer

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. A. Jurisdiction and Responsibility for Consumer Complaints Systems

Vermont is unusual among the states studied in that health insurance complaints are the responsibility of a health division, the Division of Health Care Administration, rather than an insurance regulatory agency. However the Division of Health Care Administration is a sister division to the Insurance Division in the Department of Banking, Insuranc
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Vermont

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

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E. Agency performance measures

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

Staffing
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D. Public education activities

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. D. Public education activities

Publications TDI publishes a range of brochures relating to health insurance including: Independent Review Organizations; Patient Protection Rules - Fair Play under Managed Care; Questions and Answers about your Health Care Coverage. Demand for Publications In 1999 TDI distributed 1.5 million copies of insurance related publi
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3. Insurance Company and HMO Profile Reports

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 3. Insurance Company and HMO Profile Reports

Features The TDI produces HMO and indemnity health insurance company profiles which are available electronically. Data in the profiles are as follows:
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2. Comparing Texas HMOs Annual Reports

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 2. Comparing Texas HMOs Annual Reports

Features Scope  - This report is comprised of two main sections. Firstly, it contains the results of the Consumer Assessment of Health Plans Survey (CAPHS) which was administered by an independent survey vendor certified by NCQA to a sample of Texas health plan recipients. Secondly, it contains data on consumer complaints about HMOs made t
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1. Internet Complaints Information System (ICIS)

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 1. Internet Complaints Information System (ICIS)

Features Complaint categories: ICIS, the electronic searchable database, contains closed complaints from January 1996 onwards, with key fields being the type of coverage and the reason for the complaint. Attachment 6 provides the TDI listing of these fields. TDI uses NAIC complaint codes and submits complaints data to the NAIC complaints dat
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C. Complaints Reports

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:
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B. Jurisdiction and Liaison with Health Plans

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. B. Jurisdiction and Liaison with Health Plans

New Regulatory Authority for "Downstream Risk"
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A. Jurisdiction and Responsibility for Consumer

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. A. Jurisdiction and Responsibility for Consumer Complaints Systems

Texas is a state with an interesting history, a still evolving future and multiple layered arrangements for the management of health insurance complaints.
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Texas

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

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E. Agency Performance Measures

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

Staffing The Consumer Assistance Unit (which does not include the Consumer Advocate position) has nine staff, including the Manager. This represents a 50% increase, up from 6 staff, in 1987. Of the staff, three are employed full-time on life & health complaints, 5 work on property and casualty complaints, while the Manager works across a
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D. Public education activities

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. D. Public education activities

Publications The Insurance Division produces the following material relevant to health insurance complaints:
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3. Insurance Company Annual Reports (Grievance

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 3. Insurance Company Annual Reports (Grievance data)

Features Scope  - Under the Patient Protection Act 1997 insurers are required to file annual reports on grievance statistics, utilization review procedures, quality assessment summaries (managed health care plans only) and scope of network summaries (managed health care plans only). The first reports were submitted for the calendar year 19
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2. 1998 Oregon Complaint Report Part II

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 2. 1998 Oregon Complaint Report Part II

Features
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1. Consumer Guide to Oregon Insurance Complaints

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 1. Consumer Guide to Oregon Insurance Complaints

Features The major features of the Consumer Guide report are as follows. Scope  - the report covers consumer complaints filed against major insurers in six lines of business: automobile, homeowner, life, annuities, health and health care service contractors. Health Care Service Contractors (HCSCs) include HMOs or other types of health in
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C. Complaints Reports

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

Introduction The Insurance Division produces (or disseminates) three different reports containing complaints data:

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Form Approved OMB# 0990-0379 Exp. Date 9/30/2020