A service of the California Health Care Foundation

Bill Would Require Insurers To Help Consumers With Complaints

Many Californians don’t realize they can lodge an official complaint about their health plan, and even if they do, they often have no idea how to do it, according to consumer advocates and a recent survey.

But if state Sen. Bill Monning (D-Carmel) gets his way, the health plans themselves could be required to help patients air their grievances.

Monning recently introduced a bill that would require health insurance companies to include a phone number for one of the two state consumer call centers on every insurance card they issue.

The toll-free number on a consumer’s insurance card would direct them either to the Department of Managed Health Care (1-888-466-2219) or the California Department of Insurance (1-800-927-4357), depending on which agency regulates their health plan.

The health plans also would need to ensure that doctors and their patients know all beneficiaries are entitled to language assistance and timely access to medical care. “One of the features of expanded coverage means expanded access, but that has to translate into real access,” Monning said.

He was referring, in part, to the 1.57 million Californians who have gained coverage through the state’s insurance exchange, Covered California, and the roughly 6 million more who have been newly enrolled over the past two years in Medi-Cal, the government-funded health program for people with low incomes.

Many of those people have complained of difficulty finding doctors and getting appointments.

“Eligibility without timely access is not eligibility at all,” Monning said.

Under the terms of Monning’s proposed legislation, the cost of notifying consumers about their rights would fall to the health plans.

Because the bill was just recently introduced, health plans haven’t taken an official position on it, said Nicole Evans, spokeswoman for the California Association of Health Plans.

“We are still reviewing the influx of new bills introduced and will be carefully reviewing Sen. Monning’s bill,” Evans said.

Complaints to regulators result in outcomes that are favorable to consumers about half the time, according to Betsy Imholz, special projects director at the San Francisco-based Consumers Union, an advocacy group. Besides benefitting consumers, the complaints can be helpful to the regulators who receive the calls, she said.

“This bill is good policy because you want to make sure people get full value from their health plans, and it’s also a care issue, because you want to make sure people get the care they need,” Imholz said.

“If that’s not happening, it could be a network adequacy problem, so this could be kind of an early warning to regulators” of a broader problem, she added.

Consumers Union issued a report on Feb. 19 saying that if more people with insurance problems reported them to the state, it would give regulators a more complete picture of health plan compliance.

Imholz said “tens of thousands” people across the state likely would lodge a complaint if they knew how to do it.

Another common concern consumers have about their health plans is paying more for care out of their own pockets than they think they should.

A national survey last year by Consumers Reports showed that about one-third of people with private insurance received “surprise medical bills” after their insurers paid less than they had expected.

According to the survey, 87 percent of those polled had no clue which state agency deals with health insurance complaints. And 72 percent of respondents didn’t know they had the right to appeal decisions by health plans if they thought they had been denied care unfairly.

If Monning’s bill passes and more consumers become aware of their rights, the consumer help lines at the two regulatory agencies could be swamped.

Monning called the cost of hiring more state call center employees “minimal and absorbable.” The bill is expected to be heard in the legislature starting in April.

Categories: Capitol Desk, Insurance, Syndicate

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