DEPARTMENT OF CORPORATIONS: Consumer Groups Blast Agency’s Role in HMO Oversight
Two consumer groups Friday sharply criticized the Department of Corporations' competence as an HMO watchdog and its failure to educate the public, the AP/Capitol Alert reports. The 40-page study by Consumers Union and the Center for Health Care Rights focused on DOC's performance from 1995 to 1998. It said the state's handling of grievances and its lack of scrutiny "make information on HMO complaint handling nearly meaningless to consumers." HMOs must notify the state of any complaint that goes unresolved for 30 days, but the study said DOC "does not summarize or examine those grievances in a timely fashion." Also, while reviews of HMO compliance records are required every three years, the state only met the three-year mark in one of 12 survey reviews, and the reports took an average of one year to complete. Further, the consumer groups noted, "they were difficult for consumers to get, and those that were obtained were difficult to understand. ... Insufficient promotion of the hotline in telephone books and through the media, as well as inconsistent notice of the hotline correspondence from HMOs and medical groups to consumers, hinders awareness and, ultimately, use of the hotline." Gov. Gray Davis has indicated that he favors moving HMO oversight to a new agency, although the nature of the new office is as yet unclear. Walter Zelman of the California Association of Health Plans, said, "If they can help people handle complaints better or resolve differences, I don't think the industry would be put off by that at all. The vast majority are misunderstandings or modest kinds of things that can be resolved fairly quickly" (6/13). Betsy Imholtz of Consumers Union said, "But these recommendations would apply to any new agency that is set up to oversee HMOs." A DOC spokesperson said the agency would not comment until it has had time to review the report. The report is available at www.consumersunion.org (Rose, San Diego Union- Tribune, 6/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.