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Maryland Releases Health Plan Complaint Index

By Staff Writer

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NU Online News Service, Feb. 11, 11:10 a.m. – The Maryland Insurance Administration in Baltimore has released a consumer complaint ratio index of health insurers and HMOs operating in the state.

The index covers complaints against health plans lodged with the MIA in 2001.

Of those complaints involving medical necessity issues, where the company disagreed with a physician and determined that a service was not “medically necessary,” Metropolitan Life Insurance Company had the lowest index out of 29 companies, with a justified complaint ratio of 0, the MIA reports.

A complaint ratio of one or less means a company had fewer than the expected number of complaints given its size of the market. A ratio larger than one means the company had more complaints than expected for its size, the MIA says.

The administration defines a justified complaint as one where the company changed its initial decision following an MIA investigation.

Other health plans with significantly better-than-average scores were the Kaiser Foundation Health Plan of the Mid-Atlantic (.41) and Group Hospitalization and Medical Services Inc., a CareFirst unit, which is the D.C. Blue Cross/Blue Shield plan (.51). Plans with worse-than-average scores included Cigna Healthcare of the Mid-Atlantic, Philadelphia (5.42), the MIA says.

The other category of complaints involved 40 companies with nonmedical necessity complaints such as claims payments or delivery of a service. CareFirst’s GHMSI had the lowest index at 0, says MIA, while United Health Care of the Mid-Atlantic was worse than average with an index of 6.1.

The MIA says it received 1,312 complaints of alleged medical necessity denials during 2001. For about one third of the cases, the MIA determined it did not have jurisdiction to investigate and referred the complaint to various federal agencies. Charges were withdrawn for another third of complaints, the MIA says.

The index can be found on the MIA web site, www.mdinsurance.state.md.us under Consumer Information . . . Publications.