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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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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

Unlike some states where health departments have a role in the quality regulation of HMOs, the Oregon Insurance Division has full jurisdiction over both traditional indemnity health plans and HMOs. The Oregon legislation uses the term "Health Care Service Contractors" for a HMO or other type of health insurance plan that contracts with doctors, ho
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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

The organization of health insurance complaints management in Oregon is relatively straightforward, compared to most of the other states studied. The lead agency is the Department of Consumer and Business Services. Within the Department's Insurance Division, the Consumer Assistance Unit is directly responsible for consumer complaints. Complaints
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Oregon

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

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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 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 an
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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 Department of Insurance produces a wide range of consumer publications on health insurance. In addition to the New York Consumer Guide to Health Insurers described in the previous section, other significant publications include:
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C. Complaints Reports

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

Overview The complaints reports produced by the New York Department of Insurance are among the most comprehensive of any of the states included in this study. Attachments 2 & 3 provide copies of the 1999 and 1998 reports respectively, which each include data for the previous calendar year. Both the 1998 and 1999 reports are examined as t
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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

While the Department of Health handles quality of care complaints and licensing, the Department of Insurance still has regulatory responsibility for all types of health insurance including: indemnity insurance, HMOs and POS plans). Moreover, self-insured plans are outside the Department's jurisdiction, with some of these plans contracting with PPO
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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

Two state government departments, the  Department of Insurance  and the  Department of Health , share responsibility for health insurance complaints.
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New York

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

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