Consumer Complaints on Health Insurance
Try solving the dispute yourself Insurance is a very competitive business. If you give the company a chance, you will generally find folks are willing if not eager to straighten out problems. • Start with the agent. • If not satisfied, contact the company’s customer service office; most likely it’s a toll-free number. • If customer service falls short of your expectations, ask about the company’s procedures for appealing decisions... the appeals procedure should be spelled out in your policy or benefits booklet. If you’re still not satisfied, call the Ohio Department of Insurance If your self-help efforts fail, your next stop should be the Consumer Services Division of the Ohio Department of Insurance (ODI). ODI & complaints • If your issue requires follow up with the company, we’ll send you a complaint form and instructions for filing a written complaint. • We generally will send the company a copy of your complaint and ask them to resolve it or explain their side of the story. • By law, companies must respond to the Department of Insurance — most companies do so in a timely manner. • We will review all the facts to make sure the company has upheld its contract with you and has followed insurance rules and laws. Counting complaints In 2007, ODI received a total of 2,826 complaints about health insurance from Ohio consumers. • If your complaint raises questions that cause us to contact the agent or company, we will register it in our computer as a “complaint.” • A complaint means a customer has been unhappy with the company or agent. • It does not necessarily mean the law has been broken or that anyone did anything wrong. Company complaint records — 2007 The next page shows complaint records for health insurance companies. The “complaint ratio” column can help you make apples-toapples comparisons. Complaint ratio example: if a company's complaint ratio is 1.0, it had one complaint for every $1 million in written premium. The lower the complaint ratio, the better.
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Insurance dispute tip
Provide complete, correct information to your insurance company and file your claims as soon as possible in order to avoid delays.
2007 Health Insurance Consumer Complaint Statistics
Total number: In 2007, consumer complaints on health insurance received by the Ohio Department of Insurance... Total number: In 2007, authorized companies that wrote health insurance premiums in Ohio... Total number: In 2007, authorized companies having health insurance complaints... Total number: In 2007, complaints about health insurance involving authorized companies … Total number: In 2007, health insurers that had at least ten complaints…
2,826
484
189
1,894
29
Top 10 Reasons for Health Insurance Complaints in 2007
Reason Complaints 1. Claim denial 1339 2. Unsatisfactory claim / settlement offer 274 3. Claim / settlement delay 273 4. Coverage question / benefits out-of-network 104 5. Premium refund due, but not paid 100 6. Premium amount / rating issues 93 7. Coverage / policy cancellation or non-renewal 71 8. Marketing / sales misrepresentation 59 9. Coordination of benefits 45 10. Abusive service 39 >> Total complaints represented by the above Top 10 reasons = 2,397 >> Represents 85% of the 2,822 total health insurance complaint reasons registered in 2007
2007 Health Insurance Consumer Complaint Ratios
Notes: Includes every company that received at least nine complaints about health insurance in 2007 Market Share is the company's percentage of Ohio's total written health premium in 2007 Complaint Ratio is a comparison of the company's written health premium and complaints in 2007 We've shortened company names by omitting words like Insurance and Company Health Insurers (in alphabetical order)
Aetna Life Insurance Co Amer Fam Life Assur Co Columbus/AFLAC Bankers Life and Casualty Co Central Reserve Life Insurance Co Community Insurance Co Connecticut General Life Insurance Co Conseco Health Insurance Co Conseco Senior Health Insurance Co Coventry Health and Life Insurance Co Golden Rule Insurance Co Guardian Life Insurance Co of America Humana Health Plan of Ohio Humana Insurance Co John Alden Life Insurance Co Kaiser Foundation Health Plan of Ohio Life Insurance Co of North America Medical Medical Mutual of Ohio Ohio Metropolitan Life Insurance Co Mutual of Omaha Insurance Co Nationwide Life Insurance Co Paramount Care Inc. Pyramid Life Insurance Co Summacare Inc. Time Insurance Co United American Insurance Co United Healthcare Insurance Co of Ohio United Healthcare Insurance Co United Healthcare of Ohio Inc Unum Life Insurance Co of America Total Carriers Above / 2007 All Ohio Health Carriers / 2007 Above Carriers Percent of All Health Carriers / 2007
Ohio Written Health Premium $
$410,939,804 $125,141,629 $45,155,222 $33,797,541 $4,101,938,104 $91,014,513 $20,095,187 $11,048,474 $65,929,451 $57,930,043 $107,178,588 $142,553,927 $669,197,646 $25,313,022 $559,572,101 $37,019,582 $1,915,938,840 $164,373,362 $28,263,547 $77,425,441 $393,717,047 $52,954,015 $190,590,228 $35,071,194 $49,227,443 $535,430,842 $1,318,000,560 $770,505,134 $123,030,414 $12,158,352,901 $20,291,520,433 59.92%
Ohio Market Share %
2.03% 0.62% 0.22% 0.17% 20.22% 0.45% 0.10% 0.05% 0.32% 0.29% 0.53% 0.70% 3.30% 0.12% 2.76% 0.18% 9.44% 0.81% 0.14% 0.38% 1.94% 0.26% 0.94% 0.17% 0.24% 2.64% 6.50% 3.80% 0.61% 59.92% 100.0%
Complaint Ratio
0.14 0.41 0.38 0.30 0.08 0.23 1.14 3.26 0.15 0.16 0.08 0.27 0.11 0.47 0.06 0.89 0.13 0 13 0.12 0.35 0.67 0.09 0.26 0.05 0.31 0.47 0.11 0.07 0.13 0.15 0.12 0.09
Total Complaints
59 51 17 10 309 21 23 36 10 9 9 38 71 12 32 33 249 20 10 52 36 14 10 11 23 59 89 98 19 1,430 1,894 75.50%