Consumer Complaints on Health Insurance

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					        Consumer Complaints on Health Insurance
Try solving the dispute yourself                   ODI & complaints
Insurance is a very competitive business.          • If your issue requires follow up with the
If you give the company a chance, you will           company, we’ll send you a complaint
generally find folks are willing if not eager to     form and instructions for filing a written
straighten out problems.                             complaint.
• Start with the agent.                            • We generally will send the company a
• If not satisfied, contact the company’s            copy of your complaint and ask them to
  customer service office; most likely it’s a        resolve it or explain their side of the story.
  toll-free number.                                • By law, companies must respond to
• If customer service falls short of your            the Department of Insurance — most
  expectations, ask about the company’s              companies do so in a timely manner.
  procedures for appealing decisions... the        • We will review all the facts to make sure
  appeals procedure should be spelled out            the company has upheld its contract with
  in your policy or benefits booklet.                you and has followed insurance rules and
If you’re still not satisfied, call the Ohio         laws.
Department of Insurance                            Counting complaints
If your self-help efforts fail, your next stop     In 2008, ODI received a total of 2,680
should be the Consumer Services Division           complaints about health insurance from
of the Ohio Department of Insurance (ODI).         Ohio consumers.
                                                   • If your complaint raises questions

           Call toll-free:
            1-800-686-1526
                                                     that cause us to contact the agent
                                                     or company, we will register it in our
                                                     computer as a “complaint.”
• Ask to speak with a health insurance             • A complaint means a customer has been
  analyst.                                           unhappy with the company or agent.
• The analyst will answer questions over           • It does not necessarily mean the law has
  the phone and explain any additional               been broken or that anyone did anything
  steps you should take to resolve your own          wrong.
  problem.
                                                   Company complaint records — 2008
• Our staff will give you honest, unbiased         The next page shows complaint records for
  answers — if it sounds as if the company         health insurance companies. The “complaint
  has done nothing wrong, we’ll tell you.          ratio” column can help you make apples-to-
                                                   apples comparisons.
                                                   Complaint ratio example: if a company's
               Click here                          complaint ratio is 1.0, it had one complaint
                                                   for every $1 million it collected in premiums
     to file a consumer complaint.
                                                   from Ohio customers. The lower the
                                                   complaint ratio, the better.


       Insurance dispute tip
       Provide complete, correct information to your insurance company
       and file your claims as soon as possible in order to avoid delays.
           2008 Health Insurance Complaint Statistics

           Total number:                 Total number:          Total number:           Total number:            Total number:
           In 2008, consumer             In 2008, authorized    In 2008, authorized     In 2008, complaints      In 2008, health
           complaints on health          companies having       companies having        about health             insurers having
           insurance received            health insurance       health insurance        insurance involving      at least ten
           by the Ohio Department        premiums in Ohio...    complaints in Ohio...   authorized               complaints in
           of Insurance...                                                              companies in Ohio…       Ohio…
                     2,680                      472                     178                       1,848                   30
                                         Top 10 Reasons for Health Insurance Complaints in 2008
                                Reason                                                          Complaints
                 1. Claim denial                                                        1250
                 2. Unsatisfactory claim / settlement offer                              302
                 3. Claim / settlement delay                                             291
                 4. Premium amount / rating issues                                       169
                 5. Coverage question / benefits out-of-network                          117
                 6. Coverage / policy cancellation or non-renewal                         78
                 7. Premium refund due, but not paid                                      73
                 8. Abusive service                                                       57
                 9. Refusal to Insure                                                     52
               10. Marketing / sales misrepresentation                                    45
                >> Total complaints represented by the above Top 10 reasons = 2,434
                >> Represents 88% of the 2,767 total health insurance complaint reasons registered in 2008
                        p                                                p                 g

2008 Health Insurance Complaint Ratios
Notes:
 Includes every company that received at least ten complaints about health insurance in 2008
 Market Share is the company's percentage of Ohio's total health premium in 2008
 Complaint Ratio is a comparison of the company's Ohio health premium and Ohio complaints in 2008
 We've shortened company names by omitting words like 'Insurance' and 'Company'
 * Aetna Health Inc. Ohio Corp. was folded into Aetna Life Ins. Co. in Jan. 2009
 ** Conseco Senior Health Ins. Co. changed its named to Senior Health Ins. Co. of Pennsylvania in Jan. 2009

                    Health                                     Ohio                     Ohio                 Complaint               Total
                    Insurers                               Health                   Market                   to Premium            Consumer
              (in alphabetical order)                    Premium                    Share                      Ratio               Complaints
Aetna Life Ins. Co.                                        $1,482,029,747           6.50%                       0.06                  88
AIG Life Ins. Co.                                             $10,677,752           0.05%                       0.94                  10
American Community Mutual Ins. Co.                            $52,316,894           0.23%                       0.48                  25
Amer. Fam. Life Assur. Co. Columbus/AFLAC                    $131,633,009           0.58%                       0.47                  62
Baankers Life and Casualty Co.                                $42,994,938           0.19%                       0.51                  22
Community (Anthem) Ins. Co.                                $4,185,035,306           18.35%                      0.08                  344
Connecticut General Life Ins. Co.                            $107,031,624           0.47%                       0.13                  14
Conseco Health Ins. Co.                                       $20,516,339           0.09%                       0.73                  15
Senior Health Ins. Co. of Pennsylvania **                     $10,665,484           0.05%                       1.88                  20
Coventry Health and Life Ins. Co.                             $58,513,735           0.26%                       0.26                  15
Genworth Life Ins. Co.                                        $70,571,174           0.31%                       0.84                  59
Golden Rule Ins. Co.                                          $63,981,818           0.28%                       0.25                  16
Humana Health Plan of Ohio Inc.                              $279,244,273           1.22%                       0.16                  45
Humana Ins. Co.                                              $740,676,116           3.25%                       0.09                  63
Kaiser Foundation Health Plans of Ohio                       $555,537,900           2.44%                       0.03                  18
Life Ins. Co. of North America                                $53,996,002           0.24%                       0.59                  32
Lincoln National Life Ins. Co.                                $46,355,227           0.20%                       0.24                  11
Medical Mutual of Ohio                                     $1,973,255,517           8.65%                       0.11                  213
Mega Life & Health Ins. Co.                                   $35,090,727           0.15%                       0.28                  10
Metropolitan Life Ins. Co.                                   $173,490,001           0.76%                       0.12                  21
National Union Fire Ins. Of Pittsburgh                        $10,795,575           0.05%                       1.48                  16
Nationwide Life Ins. Co.                                      $41,637,583           0.18%                       0.34                  14
Paramount Care Inc.                                          $354,423,592           1.55%                       0.06                  20
Pyramid Life Ins. Co.                                         $62,313,081           0.27%                       0.24                  15
Time Ins. Co.                                                 $34,074,128           0.15%                       0.47                  16
United American Ins. Co.                                      $44,538,642           0.20%                       0.65                  29
United Healthcare Ins. Co. of Ohio                           $526,427,080           2.31%                       0.10                  51
United Healthcare Ins. Co.                                 $1,271,374,015           5.58%                       0.09                  109
United Healthcare of Ohio Inc.                               $699,142,165           3.07%                       0.04                  28
          Ins. Co.
Unum Life Ins. Co. of America                                  $117,851,454
                                                               $117,851,454             0.52%
                                                                                        0.52%                   0.13
                                                                                                                0.13                   15
Total Carriers Above / 2008                           $13,256,190,898               58.13%                      0.11                  1,416
All Ohio Health Carriers / 2008                       $22,804,363,350               100.0%                      0.08                 1,848
Above Carriers Percent of                                  58.13%                                                                    76.62%
All Health Carriers / 2008

				
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