Cigna tops list of health insurers with justified patient complaints

February 11, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

Some health plans generate a lot more consumer complaints than others - and the Maryland Insurance Administration released yesterday its first-ever report comparing complaint rates for different insurers.

Insurance Commissioner Steven B. Larsen said the report was designed to help consumers choose health plans, but his department might also use the data to examine the "market conduct" of insurers with high rates of complaints.

The report divides complaints into two categories: disputes over whether a given service is medically necessary (if it isn't, the insurer doesn't have to pay), and other complaints, such as whether a policy covers a given service.

The number of complaints is compared with market share, so a company receiving a "complaint index" of 1.0 had as many complaints as would be expected from its market share.

Insurers with fewer complaints, relative to their size, had lower indexes.

The report, based on complaints from 2001, registers the total number of complaints and those which, after investigation by the insurance administration, were found to be justified.

Cigna Healthcare of the Mid-Atlantic logged the highest ratio of justified complaints on medical necessity, 5.42 times as many as would be expected from its market share.

Other high ratios among large insurers included Prudential Insurance (3.86) and CareFirst's Preferred Health Network (3.35).

Among large insurers with low ratios of justified complaints about medical necessity were Metropolitan Life (0), Guardian Life (0.24) and Kaiser Permanente of the Mid-Atlantic (0.41).

In other complaints, United Healthcare of the Mid-Atlantic had the highest ratio, 6.10, followed by CareFirst's FreeState Health Plan (2.65, but the plan is being phased out) and Cigna (2.37).

Three large insurers had 0 scores, meaning no justified complaints: Aetna Life, CareFirst's District of Columbia subsidiary and John Hancock.

Mike Strand, a spokesman for United Healthcare, said he hadn't reviewed the report, but based on complaint ratio reports in other states, believed "it's not a complete picture of the situation."

Strand said it was subject to being skewed by a brief problem period and didn't reflect such measures as how quickly complaints were resolved. Nonetheless, he said, "We take the results of any survey of this nature seriously."

Cigna, in a written statement, said it was committed to "work constructively with Commissioner Larsen and his staff in the best interest of our members, customers and providers, and to continually improving service and quality."

Susan Whyte Simon, a spokeswoman for Kaiser Permanente, said her HMO believed it scored well because "our physicians have the right to do what they think is necessary," and Kaiser reviews its internal complaints to look for areas where there are problems or where medical guidelines should be changed.

The report is available on the insurance administration Web site, www.mdinsurance.state. md.us, or by calling 410-468- 2000. Larsen said the department hopes to update the report annually. The insurance administration did a similar report in 2000 on auto insurance.

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