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HMO Complaints Posted Online @ Texas Web Site

MANAGED CARE July 1998. © MediMedia USA
State Initiatives

HMO Complaints Posted Online @ Texas Web Site

MANAGED CARE July 1998. ©1998 Stezzi Communications

Texas has become the first state to post on the Internet information about complaints filed against HMOs and other insurers. The Internet Complaint Information System, launched by the state's Department of Insurance, also includes complaints against auto and property insurers.

The web site, www. tdi.state.tx.us/consumer/icis/ icis1.html, is the first of its kind. It contains information on complaints filed with the department between Jan. 1, 1996 and March 31, 1998, and will be updated at least quarterly. Only complaints that have been investigated and resolved are included.

For the year that ended Aug. 31, 1997, the leading categories of complaints against HMOs had to do with alleged breaches of enrollee and provider contracts. The most common complaints from members concerned prescription coverage, reimbursement and denial or nonpayment for emergency care. The majority of provider complaints were related to denial or delay of payment.

For 1997, there were an average of 3.25 justified complaints per 10,000 enrollees among 38 HMOs operating in Texas. Foundation Health had the highest rate with 16.59 per 10,000 members. Of the 11 plans that had fewer than one complaint per 10,000 members, the largest was 142,000-member Scott and White Health Plan, with 0.21 complaints per 10,000 m45 Jrs.