Content by Keyword: Consumer Protection and Patient Safety

Staffing 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 Medicai

Publications In addition to the toll-free line, the DHCA publishes a range of reports relevant to health insurance including:

Neither the DHCA nor the Ombudsman Office publish complaints "report cards", comparing the complaints performance of individual plans. DHCA

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

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

Staffing

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

Features The TDI produces HMO and indemnity health insurance company profiles which are available electronically. Data in the profiles are as follows:

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

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

The three major sources of complaints data available to the public are:

New Regulatory Authority for "Downstream Risk"

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

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

Publications The Insurance Division produces the following material relevant to health insurance complaints:

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

Features

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