Press Release 2000-09 State Insurance Department Publishes 1999 HMO Complaint Ratios

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Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630


Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).

Media Contact: Don Harris, Public Information Officer, (602) 912-8402

For Immediate Release June 19, 2000

The Arizona Department of Insurance has published the 1999 complaint ratios for managed health care organizations. The free publication contains complaint ratios for nine health maintenance organizations, seven pre-paid dental plans and four non-profit service corporations.

These ratios represent the number of written complaints received by the Insurance Department per 1,000 individuals covered by each organization during the 1999 calendar year. Both the total number of enrollees and the written complaints are shown in this publication. It is the second year that the agency has published the managed care complaint ratios.

Arizona Insurance Director Charles R. Cohen said the brochure enables consumers to compare the number of complaints lodged against managed care organizations in Arizona last year. However, he cautioned that the complaint ratios do not reflect a determination by the Insurance Department regarding the merits of each complaint, but merely represent the total number of written complaints received by the Department against individual companies during 1999.

“The complaint ratios are useful when comparison shopping for managed care coverage,” Cohen said.

Other free publications that are available include consumer guides to group and individual health insurance. The Insurance Department recommends that consumers consult an insurance professional before purchasing coverage. Although price is always a factor, consumers should consider the company’s service to its policyholders, its overall reputation, and the type of coverage offered.

The Insurance Department uses complaint ratios to identify areas of potential regulatory non- compliance that may merit closer examination. The complaint ratio is achieved by dividing the number of individuals covered into the number of complaints, and multiplying the answer by 1,000. For example, a company with policies covering 100,000 individuals that receives 52 complaints would have a complaint ratio of 0.52.

A copy of the complaint ratio and the consumer guides to group and individual health insurance may obtained by visiting the Insurance Department web page at www.state.az.us/id or by calling or writing to: Arizona Department of Insurance, Consumer Assistance, 2910 N. 44th Street, Suite 210, Phoenix, AZ 85018; (602) 912-8444 (Phoenix); (1-800) 325-2548 (Statewide), (520) 628-6370 (Tucson).

(Complete Complaint Ratio Chart is on the Next Page)

1999 COMPLAINT RATIO SURVEY - MANAGED CARE

 

HEALTH CARE

INDIVID CHILD CARE

DENTAL CARE

VISION CARE

MEDICARE SUPPLEMENT

MEDICARE + CHOICE

TOTAL ENROLLEES

COMPLAINTS

RATIO

COMPANY NAME

INDIVID

GROUP

INDIVID

GROUP

INDIVID

GROUP

INDIVID

GROUP

INDIVID

GROUP

 

 

 

Health Care Service Organizations

 

AETNA U.S. HEALTHCARE, INC.

0

110,729

0

0

0

0

0

0

0

5,622

0

116,351

52

0.447

CIGNA HEALTHCARE OF AZ, INC.

11,867

376,953

0

0

0

0

0

3

0

37,815

6,696

433,334

64

0.148

HEALTH PLAN OF NEVADA, INC.

0

309

0

0

0

0

0

0

0

2,827

0

3,136

2

0.638

HUMANA HEALTH PLAN, INC.

0

19,190

0

0

0

0

0

0

0

21,476

0

40,666

24

0.590

INTERGROUP PREPAID HEALTH SERVICES OF AZ, INC.

26,474

256,459

0

0

0

0

0

0

0

48,614

8,328

339,875

112

0.330

MAYO HEALTH PLAN AZ, INC.

0

26,531

0

0

0

0

0

0

0

0

0

26,531

1

0.038

PACIFICARE OF AZ, INC.

5,495

98,069

0

0

2,967

0

0

0

0

88,776

0

195,307

75

0.384

SUN HEALTH MEDISUN, INC.

0

0

0

0

0

0

0

543

0

2,246

0

2,789

0

0.000

UNITED HEALTHCARE OF AZ, INC.

9,967

371,446

0

0

0

0

0

0

0

18,629

2,812

402,854

96

0.238

 

SUBTOTALS

53,803

1,259,686

0

0

2,967

0

0

546

0

226,005

17,836

1,560,843

426

 
 

Non-Profit Service Corporations

 

BLUE CROSS AND BLUE SHIELD OF AZ, INC.

69,828

389,863

1,754

0

62,358

0

0

12,793

9,847

3,613

142

550,198

70

0.127

DELTA DENTAL PLAN OF AZ, INC.

0

0

0

0

126,567

0

0

0

0

0

0

126,567

51

0.403

SIGHTCARE, INC.

0

0

0

0

0

0

28,250

0

0

0

0

28,250

0

0.000

VISION SERVICE PLAN OF AZ, INC.

0

0

0

0

0

0

443,560

0

0

0

0

443,560

0

0.000

 

SUBTOTALS

69,828

389,863

1,754

0

188,925

0

471,810

12,793

9,847

3,613

142

1,148,575

121

              

Pre-Paid Dental Plans

 

CIGNA DENTAL HEALTH PLAN OF AZ, INC.

0

0

0

436

119,639

0

0

0

0

0

0

120,075

2

0.017

EMPLOYERS DENTAL SERVICES, INC.

0

0

0

0

162,545

0

0

0

0

0

0

162,545

1

0.006

PREMIER CHOICE DENTAL, INC.

0

0

0

6,440

0

0

0

0

0

0

0

6,440

0

0.000

PRIVATE MEDICAL-CARE OF AZ, INC.

0

0

0

0

1,102

0

0

0

0

0

0

1,102

0

0.000

SAFEGUARD HEALTH PLANS, INC.

0

0

0

0

1,424

0

0

0

0

0

0

1,424

0

0.000

TOTAL DENTAL ADMINISTRATORS HEALTH PLAN, INC.

0

0

0

0

10,560

0

0

0

0

0

0

10,560

0

0.000

UNITED DENTAL CARE OF AZ, INC.

0

0

0

8,840

198,715

0

0

0

0

0

0

207,555

5

0.024

 

SUBTOTALS

0

0

0

15,716

493,985

0

0

0

0

0

0

509,701

8

 
 

TOTALS

123,631

1,649,549

1,754

15,716

685,877

0

471,810

13,339

9,847

229,618

17,978

3,219,119

555

 

 

Period: 
2000
Priority: 
09
Insurers Offering Individual Health Insurance in Arizona

Lists insurance companies that are offering health insurance to individuals and families in Arizona in 2020.  Open enrollment starts November 1st and now runs through December 17th, 2019.  Individuals can start shopping for coverage now at healthcare.gov or cuidadodesalud.gov (Spanish)

Notice of Proposed Rulemaking - Corporate Governance Annual Disclosure Model Regulation In 2019, the Arizona Legislature adopted the NAIC Corporate Governance Annual Disclosure Model Act at Arizona Revised Statutes (“ARS”) by enacting the Corporate Governance Act at Title 20, Chapter 2, Article 16 (Laws 2019, 1st Reg. Sess., Ch. 180, § 1).   The Department of Insurance (“Department”) seeks to adopt the correlate Corporate Governance Annual Disclosure Model Regulation.  ARS § 20-492.02 allows the Department to adopt rules to carry out the Act upon notice and an opportunity to be heard.  The Legislature has exempted the Department from Title 41, Chapter 6 for one year after the effective date of the Act.  (Laws 2019, 1st Reg. Sess., Ch. 180, § 2.)
Arizona's Surprise Bill Resolution Report for 2019

As shown in the attached report prepared pursuant to A.R.S. § 20-3118(A), the Department of Insurance received 91 requests for dispute resolution in Calendar Year 2019.  Of those, 53 have been resolved or closed, and health plan enrollees saved $41,538 by submitting their surprise bills for resolution.  

Not all health care bills qualify for the surprise bill resolution process.  The Department's Suprise Out-of-network Billing Dispute Resolution website (https://insurance.az.gov/soonbdr, and especially the section entitled, "I got a surprise bill. Can I submit a request for arbitration?") lists conditions when a health care bill may not qualify under Arizona law for the dispute resolution process.  But for those that do, the enrollee will only be responsible for paying the enrollee's cost-sharing amounts (copay, coinsurance and deductible) if the enrollee provides information the Department needs, and participates in an informal settlement teleconference with the health care insurer and the health care provider.

Fire Readiness and Your Insurance Coverage

Complete three steps to be prepared

STEP ONE: Inventory your contents. 
Making a record of what you have provides two major benefits.  First, it could help you estimate the cost of replacing your contents, which you could use to make sure you have enough insurance coverage.  Second, it will help you identify missing or destroyed items if you need to file an insurance claim. Keep your inventory records in a safe place outside your home, such as a safe deposit box at a bank, or in a secure online location. 

  • The National Association of Insurance Commissioners (NAIC) has a free app called, “MyHome Scr.APP.book,” available from Google Play and from the Apple App Store, which can help you keep track of your personal property. 
  • The Insurance Information Institute provides advice that can make creating a home inventory easier (https://www.iii.org/article/how-create-home-inventory).

STEP TWO: Understand what your homeowners’ insurance policy covers.
If you do not have your policy on hand, get a copy from your insurance company or insurance agent. Then, make sure your policy provides enough coverage for your dwelling, contents and additional living expenses.

  • Dwelling Coverage:  This pays to reconstruct your home, from ground up if necessary.  It does not include the cost of the land on which your home sits because you will still have that, but it should include the cost to remove a destroyed structure and replace it a home that is similar to what you had prior to the fire.
  • Contents Coverage:  This pays to repair or replace your personal belongings. Your policy may provide contents coverage based on a set percentage of your dwelling coverage, but you can pay for more contents coverage if you think you need it. 
    • Check to see if your coverage will pay “actual cash value” or “replacement cost.”  Actual cash value (ACV) means what an item was worth when it was destroyed based on its initial cost minus depreciation or loss in value due to its age, condition and wear-and-tear.  Replacement cost (RC) means the cost to replace or repair damaged or destroyed property with materials of “like kind and quality”. Claims for damaged or destroyed items will initially be paid based on the ACV of the item.  When the item is replaced, a copy of the receipt must be provided to the insurance company to obtain payment of the balance owed.  Many policies require the damaged items to be replaced within six (6) months.
    • If you have expensive items, such as artwork, jewelry or computers, you can purchase or increase “scheduled” property coverage to make sure you have sufficient coverage for those items.
  • Additional Living Expense (a.k.a. Loss of Use) Coverage. This pays additional costs you may resulting from the property damage.  For example, if you are not able to live in your home, your policy may cover the costs of lodging and food, boarding your pets, etc.

Importantly, insurance policies are often lengthy, detailed documents.  Do not hesitate to contact your agent or insurance company representative if you have any questions. 

STEP THREE: Minimize your fire risk.
Periodically inspect your home for overloaded power strips, damaged electrical cords or other potential fire hazards.  Keep vegetation and combustible materials away from your home.  If you are in an area that is at higher risk for wildfire, follow “Avoiding Wildfire Damage” guidelines published by the Federal Emergency Management Agency (https://www.fema.gov/pdf/hazard/wildfire/wdfrdam.pdf). 

Remain organized and keep good records

If you are the victim of a fire, remaining organized after an event can be difficult, but it is essential so that you can receive the benefits that your insurance coverage provides.

  • Keep all receipts for living expenses (housing, food, etc.) and for all items that you replace or repair.  Insurance companies may require that you submit original receipts. You should either copy, scan or take clear photos of receipts to provide yourself a backup. 
  • Take photos of your property and the damage.
  • Keep records of all your conversations, emails and letters about your claim with your insurance company and agent.  Take notes of conversations, documenting who you talked to, when you talked to them and what you were told. When possible, send an e-mail message to the person with whom you had the conversation to confirm your understanding of what you were told.
  • Do not throw away or destroy damaged property until your insurer inspects the property and tells you in writing/e-mail that you can do so.
  • Take an inventory of the damaged contents.  If you have an inventory from before the fire, use it to help identify items that were damaged/destroyed. 
  • When the insurer inspects the damage, do a complete walkthrough of your property and point out any issues or concerns you have.
  • When beginning the repair process, get multiple repair estimates from licensed contractors (look up records on the Arizona Registrar of Contractors “Contractor Search” page at https://roc.az.gov/contractor-search) with good reputations (look up records on the Better Business Bureau website at https://www.bbb.org).
  • Don’t delay.  Insurance policies generally have restrictions on how long after a fire you can file claims.

Persons with disabilities may request materials in an alternative format by contacting our Americans with Disabilities Act Coordinator at (602) 364-0108. 

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