For-Profit Health Plans Draw More Complaints

July 12, 2010 -- For-profit health plans drew more than their fair share of consumer complaints to the Oregon Insurance Division in 2009, based on a report posted by the division on-line today.

 

And according to a national survey of how well insurers paid physicians, Regence BlueCross BlueShield of Oregon scored the fourth worst in the country.

 

The national PayerView survey by AthenaHealth collects data from more than 22,000 providers covering 39 million charges and $7 billion in medical bills. The information comes from doctors who use AthenaHealth billing software, although the exact number of doctors who submit claims to Regence this way is unknown.

 

The survey showed Regence denied physician claims 12 percent of the time and that the outcome of a claim matched the eligibility response given to the physician just 23 percent of the time. Samantha Meese, a spokeswoman for Regence, refuted the survey.

 

Meese said less than 2 percent of claims received by Regence are denied.

 

“We have never seen this tool, so I can't provide comment on this specific tool, their methodology or the results,” Meese said. “What I can tell you is that 98 percent of Regence claims are approved, and paid promptly and accurately. Less than 2 percent are denied, most commonly for things such as duplicate billings or coding errors.”

 

Meese pointed to strong scores the insurer earned for quality measures among health plans nationally called eValue8.

 

In the Oregon consumer complaint report released today, Clear One, HealthNet and LifeWise – all for-profit insurers – each drew twice the number of consumer complaints that would be expected based on the amount of premiums and members each company had in 2009.

 

Among non-profit insurers, ODS Health Plans generated three times its share of complaints, the most among dominant insurers in the state. All other major carriers in Oregon scored at or below what would be expected.

 

Regence, meanwhile, drew 101 confirmed cases, about two-thirds what would be expected from $2.3 billion in premiums. Kaiser, the next largest health insurer in Oregon with $1.9 billion in premiums last year, had just 26 confirmed complaints, less than half its expected number of complaints.

 

The report includes statistics on total complaints received and confirmed complaints – those deemed legitimate which may or not have been adjudicated by the insurer – among a range of insurance products sold in Oregon such as auto, life and homeowners insurance. However, details of the complaints are exempt from public records law.

 

 

 

For the 2010 Report for Oregon Insurance Complaints click here.

 

For the AthenaHealth PayerView survey click here.

 

To reach the consumer advocacy unit of the Oregon Insurance Division dial 503-947-7984 or 888-877-4894 (toll-free).

 

For the financial regulation section, call 503-947-7982

 

For the product licensing unit, call 503-947-7981

 

For more information from the Oregon Insurance Division visit www.insurance.oregon.gov

 

For ways to file a grievance with several state agencies click here.