To help consumers navigate the sometimes daunting rules of HMOs, a group of three medical charities said it will begin a pilot ombudsman program in the Sacramento area next year.
The three--the Sierra Health Foundation, Kaiser Family Foundation and the California Wellness Foundation--said they hope the $1.6-million project will become a state and national model for HMO consumer programs. The Kaiser foundation is not affiliated with Kaiser Permanente.
The program, scheduled to begin in March 1997, will include a telephone hotline and in-person counseling services to help consumers answer general questions about health maintenance organizations and to resolve problems involving denial of service and other issues.
A key aspect of the project will be to collect and report information about the kinds of problems consumers are having with HMOs.
"The public doesn't have the foggiest idea of what sorts of problems consumers are having" with HMOs, said consumer advocate Peter Lee, who will head the ombudsman program. "Are these anecdotes [about HMO problems] really evidence of systemic problems or are they the exception?"
The program will be administered by the Center for Health Care Rights, an L.A. consumer advocacy group. Legal Services of Northern California will provide the ombudsman services.