September 5, 2018
Contact: Richard Loconte, 212-709-1691
DFS ISSUES 2018 EDITION OF NEW YORK CONSUMER GUIDE TO HEALTH INSURERS
Guide Ranks Insurers by Complaints, External Appeals, Grievances and Quality of Care to Empower New York Consumers in Their Choice of Health Insurance Providers
Financial Services Superintendent Maria T. Vullo today announced that the Department of Financial Services (DFS) has released the 2018 edition of the New York Consumer Guide to Health Insurers to inform New Yorkers about the health insurance products offered in New York State and how they work, and to help consumers choose a health insurance company based on quality of care and service. The annual guide is part of DFS’s ongoing efforts to protect consumers and to ensure a continued robust health insurance market.
“New York continues to be at the forefront in the national battle to maintain the gains that the ACA has provided: lower rates, better coverage and a healthier individual market” said Superintendent Vullo. “The 2018 edition of the New York Consumer Guide to Health Insurers furthers DFS’s mission and is designed to provide information that empowers New Yorkers to make the best decisions regarding their healthcare providers.”
The New York Consumer Guide to Health Insurers ranks insurers by complaints, internal and external appeals, grievances, and dispute resolution, as well as by quality of care in various categories such as child and adolescent health, women’s health, adult health and behavioral health. It also includes information on health insurers’ accreditation, and resources such as contact information for insurers, how to make a complaint and how to apply for health insurance offered on New York’s health insurance marketplace.
The information in the guide is based on complaint, appeal and grievance information, as well as independent dispute resolution information data from 2017. The guide lists the following information:
- Rank: Each health insurance company’s rank is based on the number of prompt pay complaints upheld, relative to the company’s premiums. A lower number results in a higher ranking. A higher ranking means that the health insurance company had fewer complaints relative to its size.
- Total Complaints: Total number of complaints closed by DFS in 2017. Complaints typically involve issues about prompt payment, reimbursement, coverage, benefits, rates and premiums.
- Total Prompt Pay Complaints: Total number of prompt pay complaints closed by DFS in 2017. Large health insurance companies may receive more complaints because they have more members and pay more claims than smaller health insurance companies.
- Upheld Prompt Pay Complaints: Number of closed prompt pay complaints where DFS determined that the health insurance company was not processing claims in a timely manner. Prompt pay complaints upheld by DFS are used to calculate the prompt pay complaint ratio and ranking.
- Premiums: Dollar amount generated by a health insurance company in New York State during 2017. Premiums are used to calculate the prompt pay complaint ratio so that health insurance companies of different sizes can be compared fairly. Premium data exclude Medicare and Medicaid.
- Prompt Pay Complaint Ratio: Number of prompt pay complaints upheld divided by the health insurance company’s premiums.
For 2017, the insurers with the highest overall ranking based on the lowest number of complaints are:
- MVP Health Services Corp.
- Independent Health Benefits Corp.
- Independent Health Association Inc.
- Genworth Life Insurance Company of New York
- Community Blue (Health Now)
- Delta Dental of New York (dental coverage only)
- John Hancock Life & Health Insurance Co.
- Eastern Vision Service Plan (vision coverage only)
- Principal Life Insurance Co.
- HM Life Insurance Company of New York
New Yorkers who have concerns with their health insurance company should first contact their insurer’s Member Services Department. If the problem is not resolved to the consumer’s satisfaction, he or she may contact one of the following:
For issues concerning payment, reimbursement, coverage, benefits and premiums, contact:
Consumer Assistance Unit, New York State Department of Financial Services
For denials of coverage of health care services because a health insurance company considers them experimental, investigational, not medically necessary, a clinical trial, a rare disease treatment, an out-of-network service or, an out-of-network referral, contact:
New York State Department of Financial Services
New York State External Appeal Division
Email: [email protected]
Online: Submit an External Appeal
For issues concerning HMO quality of care, contact:
New York State Department of Health
Managed Care Complaint Unit
Online: Department of Health
For issues concerning insurance fraud, contact:
New York State Department of Financial Services Insurance Frauds Bureau
Online: Scams, Schemes & Fraud
A copy of the Consumer Guide to Health Insurers can be found here.