WASHINGTON: HMOs Not Obeying Disclosure Law, Group Says
HMOs "aren't complying with the state Managed Care Disclosure Act of 1996," according to Washington Citizen Action (WCA) and the American Association of Retired Persons. The two groups released findings Monday that were based "on a study in which volunteers posing as prospective enrollees called health plans." According to WCA, the volunteer callers were often greeted with "[r]ude and evasive responses." The survey also found that few customer service representatives at the HMOs could answer questions about specialist referrals, prescription drug coverage or grievance procedures ( AP/Tacoma Tribune News, 8/4). The Seattle Times reports that the watchdog group WCA held a joint press conference with state Insurance Commissioner Deborah Senn (D) where they released the study's finding. "We see that each plan has interpreted the requirements of the law differently," said Senn, whose office is in charge of enforcing the law, which "requires HMOs to disclose basic information to consumers about benefits, premiums, claims procedures and grievance guidelines" (Beason, 8/4). Senn said her office would investigate the findings, possibly levying fines against the HMOs found to be in violation of the law.
Help Needed, Not Penalties
Basil Badley, a health insurer lobbyist, said levying fines is not the proper corrective measure. "If the plans aren't doing it correctly, they ought to be worked with so they can do it right. I would hope she [Senn] tries to correct it rather than fine ... everybody," said Badley, noting that many HMOs have difficulty educating their representatives on the "intricacies of health care law." The AP/News Tribune reports that "industry spokesmen said they would welcome assistance" in complying with the law. "I can tell you, Group Health Cooperative as a consumer-governed organization, thinks it's a good thing if regulators can help consumers get the information they need when they need it," said Don Glickstein, spokesperson for GHC (8/4). Chris Bruzzo, spokesperson for the state' largest insurer, Regence Blue Shield, said some HMOs "have tried to make improvements in customer service." He said Regence last year sponsored a bill in the state Legislature "that would have standardized the customer-grievance process, but the bill was killed" (Seattle Times, 8/4).