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| Your right to Complain. Back to Consumer Guide list | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| What to do. | Many complaints can
be solved by contacting your health plan directly. Ask the customer service
personnel to assist you, and if you are not satisfied, ask them about their
complaint process. Each managed care organization is required to have a
clearly defined complaint process and to make that process know to its members.
You may also complain in writing to the Colorado Division of Insurance (at 1560 Broadway, Suite 850, Denver, CO 80202, or call 303-894-7499.) The Division records how many written complaints are filed against licensed health plans and makes that information available to consumers (see chart.) Colorado Division of Insurance website is http://www.dora.state.co.us/Insurance/mainmenu.htm/ |
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| What does it mean? | The chart shows how many complaints there were about a health plan in relation to how much the company collected in premiums. A complaint ratio of 1.58, for example, means that the plan had approximately 1.58 complaints per million dollars charged in premiums. Keep in mind, however, that no judgement is made as to whether the complaint is justified. In addition, the Division cautions consumers that small differences in complaint ratios are not very significant. Both HMOs and POSs are included here. Complaints about federally funded programs, such as Medicare and Medicaid managed care plans are not included. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Comparing complaint ratios as of August 12, 2002 |
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| Complaints for 1996. |
The last three rows in the chart show how the average complaint ratio of health plans compared to those of other types of insurance in Colorado. As you can see, the accident and health insurance (non-HMO) complaint ratio is about three times higher than that of health plans. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Data from the Division of Insurance, 1997 |
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