WASHINGTON, D.C. - Be prepared for a more educated consumer, as the National Association of Insurance Commissioners (NAIC) engages in an outreach initiative to inform consumers of HMO-related problems and steps to resolve complaints.
The association reported last week that 35,000 HMO-related complaints are expected from U.S. consumers during 1998. These include grudges about HMOs and other healthcare insurers, says Glenn Pomeroy, NAIC president and North Dakota insurance commissioner.
Examples of problems healthcare consumers will face and how they should protect themselves are outlined in a new NAIC consumer action kit, "Resolving Health Insurance Complaints," available both on the Web (http://www.naic.org) and from state insurance departments. The kit would be a smart read for healthcare communicators as they prepare for the onslaught of HMO-related complaints.
The most frequent complaints arise from healthcare claim denials, disputed claims, slow payments by health insurers and premium-related matters. Some complaints stem from healthcare providers - doctors and hospitals - that want to provide a treatment not covered in a patient's healthcare plan, says Steve Larson, Maryland insurance commissioner.
The NAIC's research is meant to arm consumers with the knowledge that 77 million Americans come under state insurance regulations and that the NAIC is an available resource for problem resolution.
The outreach initiative is an ongoing plan informing consumers of these services. The first phase was a press conference, Sept. 10, covered by major news organizations like AP, CBS, Conus, Fox, Hearst Broadcasting, Reuters, The Wall Street Journal and The Washington Post. The NAIC is working on stories with the Los Angeles Times and USA Today.
The next step is creating a public service announcement about the campaign.
"We are here to help. The reality is that state insurance departments stand ready to provide assistance to consumers who have been mistreated or mishandled by an HMO or other health insurer," Pomeroy says.
The NAIC is the organization of insurance regulators from the 50 states, the District of Columbia and the four U.S. territories. (NAIC, 816/842-3600)
FAST FACTS
- 77 million Americans are covered by state insurance regulations
- 35,000 HMO-related complaints are expected from consumers this year.
Source: NAIC