Consumer Advocates Call HMO Report Inadequate

As fall approaches, people across Orange County once again face a decision to either stick with their health insurance plan for another year--or switch.

Surely, consumers can use all the help they can get in evaluating plans. Still, they needn’t bother consulting the state’s first annual report on complaints lodged against health maintenance organizations by consumers.

The report by the Department of Corporations, which regulates health maintenance organizations, lists the total number of complaints received last year against each plan. It also breaks the totals into 32 categories, ranging from poor doctor attitude, to long wait times for appointments, to denial of treatment.

Trouble is, say consumer advocates, the information contained in the report is of limited use. “This report should not just be taken with a grain of salt, but a whole salt lick,” says Peter Lee, a lawyer for the Los Angeles-based Center for Healthcare Rights.

Lee acknowledged that while his group and others have pushed the agency to compile such data on health plans, the agency’s first report can’t be used to compare plans. Lee noted, for instance, that the report draws statistics both from plans that advised their members about the toll-free complaint hot line the agency set up last fall, as well as those that delayed spreading the word until this year. As a result, the rate of complaints against plans that were slow to notify their members may appear artificially low, Lee says.

Jamie Court, director for Los Angeles-based Consumers for Quality Care, also points out that the report lacks complaint data from Medicare and Medi-Cal recipients.

A department spokesman says the report provides HMO information required by law. The agency is deliberately avoiding any interpretation of the data, which should be considered along with various other reports on managed care plans, the spokesman said.