The New York State Department of Financial Services ("DFS") has released the 2019 edition of the New York Consumer Guide to Health Insurers.
The guide ranks insurers by complaints, internal and external appeals, grievances, and dispute resolution, as well as by quality of care in various categories such as child and adolescent health, women's health, adult health, and behavioral health.
It also includes information on health insurers' accreditation and resources such as contact information for insurers, how to make a complaint, and how to apply for health insurance offered on New York's health insurance marketplace.
The guide lists the following information:
- Rank: Each health insurance company's rank is based on the number of prompt pay complaints upheld, relative to the company's premiums. A lower number results in a higher ranking. A higher ranking means that the health insurance company had fewer complaints relative to its size.
- Total complaints: This represents the total number of complaints closed by the DFS in 2018. Complaints typically involve issues about prompt payment, reimbursement, coverage, network adequacy, benefits, rates, and premiums.
- Total prompt pay complaints: This is the total number of prompt pay complaints closed by the DFS in 2018. Large health insurance companies may receive more complaints because they have more members and pay more claims than smaller health insurance companies.
- Upheld prompt pay complaints: Number of closed prompt pay complaints where the DFS determined that the health insurance company was not processing claims in a timely manner. Prompt pay complaints upheld by the DFS are used to calculate the prompt pay complaint ratio and ranking.
- Premiums: This ranking represents the dollar amount generated by a health insurance company in New York State during 2018. Premiums are used to calculate the prompt pay complaint ratio so that health insurance companies of different sizes can be compared fairly. Premium data exclude Medicare and Medicaid.
- Prompt pay complaint ratio: Number of prompt pay complaints upheld divided by the health insurance company's premiums.
Learn more: 2019 Consumer Guide to Health Insurers.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].